Research Article
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Oncological Outcomes in High-grade pTa Bladder Cancer

Year 2022, Volume: 19 Issue: 3, 536 - 541, 27.12.2022
https://doi.org/10.35440/hutfd.1129783

Abstract

Background: It was aimed to evaluate the oncological outcomes in patients with primary Ta, high grade patholo-gy, to determine possible risk factors for recurrence, and to show the effect of secondary TUR (re-TUR) on oncological outcomes.
Materials and Methods: Data of patients who underwent TUR-BT in our clinic between January 2000 and De-cember 2020 were retrospectively analyzed. Patients with pTa, high grade or G3 urothelial carcinoma were included. The demographic and histopathological data, development of relapse and progression and their dura-tion time were scanned. The patients were divided into two groups, those with and without recurrence, and those with re-TUR or not. Comparison of categorical variables was done with Pearson chi-square test and Fisher's Exact test. In quantitative data, Student's t-test was used for normally distributed variables and Mann-Whitney U test was used for others. Type I error probability was accepted as α = 0.05 for all tests. Kaplan-Meier survival curves with 95% CI were used to determine the effect of re-TUR on bladder tumor recurrence.
Results: Total of 63 patients were male (87.5%) among 72 patients. 21 patients had recurrence and 4 patients had progression at 25 months of followup. Recurrence occurred in 14 patients (66.7%) within the first year. The majority of recurrent pathologies were pTa (82%) bladder tumors. Radical cystectomy and urinary diversion were applied to one of 2 patients with muscle invasion, and multimodal therapy was applied to the other. Occu-pational chemical exposure was statistically significantly higher in the recurrent group (p = 0.001). There was no statistically significant difference in terms of recurrence-free survival between with and without re-TUR (p=0.432).
Conclusions: This study demonstrated the negative effect of occupational chemical exposure on recurrence in highgrade pTa bladder cancers. Even 5 years after the first diagnosis, recurrence and progression can be ob-served.

Key Words: Bladder cancer, survival, progression

References

  • 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA: A Cancer Journal for Clinicians. 2020;70(1):7–30.
  • 2. Burger M, Catto JWF, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, et al. Platinum Priority – Review – Bladder Cancer Epidemiology and Risk Factors of Urothelial Bladder Cancer. European Urology. 2013;63:234–41.
  • 3. Sylvester RJ, van der Meijden APM, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: A combined analysis of 2596 patients from seven EORTC trials. European Urology. 2006;49(3):466–77.
  • 4. M. Babjuk, M. Burger, E. Compérat, P. Gontero, A.H. Mostafid, J. Palou, B.W.G. van Rhijn, M. Rouprêt, S.F. Shariat, R. Sylvester RZ. EAU Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and CIS). 2020.
  • 5. Soukup V, Čapoun O, Cohen D, Hernández V, Burger M, Compérat E, et al. Risk Stratification Tools and Prognostic Models in Non–muscle-invasive Bladder Cancer: A Critical Assessment from the European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel. European Urology Focus. 2020;6(3):479–89.
  • 6. Tully KH, Moschini M, von Rundstedt FCE, Aziz A, Kluth LA, Necchi A, et al. Impact of tumor size on the oncological outcome of high-grade nonmuscle invasive bladder cancer – examining the utility of classifying Ta bladder cancer based on size. Urologic Oncology: Seminars and Original Investigations. 2020 Nov 1;38(11):851.e19-851.e25.
  • 7. Miyake M, Matsuyama H, Teramukai S, Kinoshita F, Yokota I, Matsumoto H, et al. A new risk stratification model for intravesical recurrence, disease progression, and cancer-specific death in patients with non-muscle invasive bladder cancer: the J-NICE risk tables. International Journal of Clinical Oncology. 2020 Jul 1;25(7):1364–76.
  • 8. Sylvester RJ, Rodríguez O, Hernández V, Turturica D, Bauerová L, Bruins HM, et al. European Association of Urology (EAU) Prognostic Factor Risk Groups for Non–muscle-invasive Bladder Cancer (NMIBC) Incorporating the WHO 2004/2016 and WHO 1973 Classification Systems for Grade: An Update from the EAU NMIBC Guidelines Panel[Formula present. European Urology. 2021 Apr 1;79(4):480–8.
  • 9. Tinay I, Baltaci S, Demirdag C, Akdogan B, Yucetas U, Simsekoglu MF, et al. Ta grade 3/high grade non-invasive bladder cancer: Should we perform a second TUR? International Journal of Clinical Practice. 2021 Apr 1;75(4).
  • 10. Kilinc MF, Sonmez NC, Dalkilic A, Arisan S, Guney S. Analysis of results of recurrence and progression rates of high-grade Ta bladder cancer and comparison with results of high-grade T1. Urologia. 2014;81(4):237–41.
  • 11. Cumberbatch MGK, Cox A, Teare D, Catto JWF. Contemporary occupational carcinogen exposure and bladder cancer. JAMA Oncology. 2015;1(9):1282–90.
  • 12. Carta A, Pavanello S, Mastrangelo G, Fedeli U, Arici C, Porru S. Impact of occupational exposures and genetic polymorphisms on recurrence and progression of non-muscle-invasive bladder cancer. International Journal of Environmental Research and Public Health. 2018;15(8).
  • 13. Selinski S, Bürger H, Blaszkewicz M, Otto T, Volkert F, Moormann O, et al. Occupational risk factors for relapse-free survival in bladder cancer patients. Journal of Toxicology and Environmental Health - Part A: Current Issues [Internet]. 2016;79(22–23):1136–43. Available from: http://dx.doi.org/10.1080/15287394.2016.1219606
  • 14. Lebret T, Bohin D, Kassardjian Z, Herve JM, Molinie V, Barre P, et al. Recurrence, progression and success in stage Ta grade 3 bladder tumors treated with low dose bacillus Calmette-Guerin instillations. Journal of Urology. 2000;163(1):63–7.
  • 15. Matsumoto K, Kikuchi E, Horiguchi Y, Tanaka N, Miyajima A, Nakagawa K, et al. Late Recurrence and Progression in Non-muscle-invasive Bladder Cancers After 5-year Tumor-free Periods. Urology [Internet]. 2010;75(6):1385–90. Available from: http://dx.doi.org/10.1016/j.urology.2009.09.088
  • 16. Gontero P, Gillo A, Fiorito C, Oderda M, Pacchioni D, Casetta G, et al. Prognostic factors of “High-Grade” Ta bladder cancers according to the WHO 2004 classification: Are these equivalent to “High-Risk” non-muscle-invasive bladder cancer? Urologia Internationalis. 2014;92(2):136–42.
  • 17. Quhal F, D’Andrea D, Soria F, Moschini M, Abufaraj M, Rouprêt M, et al. Primary Ta high grade bladder tumors: Determination of the risk of progression. Urologic Oncology: Seminars and Original Investigations. 2021;39(2):132.e7-132.e11.
  • 18. Divrik RT, Ahin AF, Yildirim Ü, Altok M, Zorlu F. Impact of routine second transurethral resection on the long-term outcome of patients with newly diagnosed pT1 urothelial carcinoma with respect to recurrence, progression rate, and disease-specific survival: A prospective randomised clinical trial. European Urology. 2010;58(2):185–90.
  • 19. Chang SS, Boorjian SA, Chou R, Clark PE, Daneshmand S, Konety BR, et al. Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline. Journal of Urology [Internet]. 2016;196(4):1021–9. Available from: http://dx.doi.org/10.1016/j.juro.2016.06.049
  • 20. Taoka R, Matsuoka Y, Kohashiguchi K, Miura T, Tohi Y, Miyauchi Y, et al. Impact of second transurethral resection on recurrence in patients with high-grade Ta bladder cancer. International Journal of Urology. 2020;27(12):1130–5.

Yüksek Dereceli pTa Mesane Kanserinde Onkolojik Sonuçlar

Year 2022, Volume: 19 Issue: 3, 536 - 541, 27.12.2022
https://doi.org/10.35440/hutfd.1129783

Abstract

Amaç
Primer Ta, high grade patolojili hastalarda onkolojik sonuçların değerlendirilmesi, nüks için olası risk faktörlerin belirlenmesi ve ikincil TUR (re-TUR) yapılmasının onkolojik sonuçlara olan etkisinin gösterilmesi amaçlandı.
Materyal ve Metod
Ocak 2000 ile Aralık 2020 tarihleri arasında kliniğimizde TUR-MT yapılan hastaların verileri retrospektif olarak incelendi. pTa, high grade veya G3 ürotelyal karsinom patolojisi olan hastalar çalışmamıza dahil edildi. Hastaların demografik verileri, yapılan TUR-MT operasyonlarına ait histopatolojik verileri, nüks ve progresyon gelişimi ve bunların süreleri tarandı. Hastalar öncelikle nüks saptanan ve saptanmayanlar olarak sonrasında ise re-TUR yapılanlar ve yapılmayanlar olarak iki gruba ayrıldı.
Bulgular
Toplam 72 hastadan 63’ü erkekti (%87,5). Ortanca 25 aylık takipte 21 hastada nüks, 4 hastada ise progresyon saptandı. On dört hastada (%66,7) nüks ilk bir yıl içerisinde gelişti. Nüks patolojilerinin büyük çoğunluğu pTa (%82) mesane tümörüydü. Kasa invaze olan 2 hastanın birine radikal sistektomi ve üriner diversiyon, diğer hastaya multimodal tedavi uygulandı. Nüks gelişen grupta mesleki kimyasal maruziyeti istatistiksel anlamlı daha fazlaydı (p=0,001). Re-TUR yapılan grupta 9 (%37,5) hastada nüks görülürken, yapılmayan grupta 12 (%25) hastada nüks görüldü (p=0,271). Re-TUR yapılan ve yapılmayan grup arasında nükssüz sağkalım açısından istatistiksel anlamlı farklılık saptanmadı (p=0,432).
Sonuç
Bu çalışma ile Ta, high grade mesane kanserlerinde mesleki kimyasal maruziyetlerinin nüks üzerine negatif etkisi gösterildi. 5 yıl sonrasında dahi nüks ve progresyon gözlenebilmektedir. Re-TUR yapılmasının nükssüz sağ kalım üzerine belirgin etkisi görülmese de bu konuda daha fazla hasta sayısına sahip çok merkezli çalışmalara ihtiyaç vardır.

References

  • 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA: A Cancer Journal for Clinicians. 2020;70(1):7–30.
  • 2. Burger M, Catto JWF, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, et al. Platinum Priority – Review – Bladder Cancer Epidemiology and Risk Factors of Urothelial Bladder Cancer. European Urology. 2013;63:234–41.
  • 3. Sylvester RJ, van der Meijden APM, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: A combined analysis of 2596 patients from seven EORTC trials. European Urology. 2006;49(3):466–77.
  • 4. M. Babjuk, M. Burger, E. Compérat, P. Gontero, A.H. Mostafid, J. Palou, B.W.G. van Rhijn, M. Rouprêt, S.F. Shariat, R. Sylvester RZ. EAU Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and CIS). 2020.
  • 5. Soukup V, Čapoun O, Cohen D, Hernández V, Burger M, Compérat E, et al. Risk Stratification Tools and Prognostic Models in Non–muscle-invasive Bladder Cancer: A Critical Assessment from the European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel. European Urology Focus. 2020;6(3):479–89.
  • 6. Tully KH, Moschini M, von Rundstedt FCE, Aziz A, Kluth LA, Necchi A, et al. Impact of tumor size on the oncological outcome of high-grade nonmuscle invasive bladder cancer – examining the utility of classifying Ta bladder cancer based on size. Urologic Oncology: Seminars and Original Investigations. 2020 Nov 1;38(11):851.e19-851.e25.
  • 7. Miyake M, Matsuyama H, Teramukai S, Kinoshita F, Yokota I, Matsumoto H, et al. A new risk stratification model for intravesical recurrence, disease progression, and cancer-specific death in patients with non-muscle invasive bladder cancer: the J-NICE risk tables. International Journal of Clinical Oncology. 2020 Jul 1;25(7):1364–76.
  • 8. Sylvester RJ, Rodríguez O, Hernández V, Turturica D, Bauerová L, Bruins HM, et al. European Association of Urology (EAU) Prognostic Factor Risk Groups for Non–muscle-invasive Bladder Cancer (NMIBC) Incorporating the WHO 2004/2016 and WHO 1973 Classification Systems for Grade: An Update from the EAU NMIBC Guidelines Panel[Formula present. European Urology. 2021 Apr 1;79(4):480–8.
  • 9. Tinay I, Baltaci S, Demirdag C, Akdogan B, Yucetas U, Simsekoglu MF, et al. Ta grade 3/high grade non-invasive bladder cancer: Should we perform a second TUR? International Journal of Clinical Practice. 2021 Apr 1;75(4).
  • 10. Kilinc MF, Sonmez NC, Dalkilic A, Arisan S, Guney S. Analysis of results of recurrence and progression rates of high-grade Ta bladder cancer and comparison with results of high-grade T1. Urologia. 2014;81(4):237–41.
  • 11. Cumberbatch MGK, Cox A, Teare D, Catto JWF. Contemporary occupational carcinogen exposure and bladder cancer. JAMA Oncology. 2015;1(9):1282–90.
  • 12. Carta A, Pavanello S, Mastrangelo G, Fedeli U, Arici C, Porru S. Impact of occupational exposures and genetic polymorphisms on recurrence and progression of non-muscle-invasive bladder cancer. International Journal of Environmental Research and Public Health. 2018;15(8).
  • 13. Selinski S, Bürger H, Blaszkewicz M, Otto T, Volkert F, Moormann O, et al. Occupational risk factors for relapse-free survival in bladder cancer patients. Journal of Toxicology and Environmental Health - Part A: Current Issues [Internet]. 2016;79(22–23):1136–43. Available from: http://dx.doi.org/10.1080/15287394.2016.1219606
  • 14. Lebret T, Bohin D, Kassardjian Z, Herve JM, Molinie V, Barre P, et al. Recurrence, progression and success in stage Ta grade 3 bladder tumors treated with low dose bacillus Calmette-Guerin instillations. Journal of Urology. 2000;163(1):63–7.
  • 15. Matsumoto K, Kikuchi E, Horiguchi Y, Tanaka N, Miyajima A, Nakagawa K, et al. Late Recurrence and Progression in Non-muscle-invasive Bladder Cancers After 5-year Tumor-free Periods. Urology [Internet]. 2010;75(6):1385–90. Available from: http://dx.doi.org/10.1016/j.urology.2009.09.088
  • 16. Gontero P, Gillo A, Fiorito C, Oderda M, Pacchioni D, Casetta G, et al. Prognostic factors of “High-Grade” Ta bladder cancers according to the WHO 2004 classification: Are these equivalent to “High-Risk” non-muscle-invasive bladder cancer? Urologia Internationalis. 2014;92(2):136–42.
  • 17. Quhal F, D’Andrea D, Soria F, Moschini M, Abufaraj M, Rouprêt M, et al. Primary Ta high grade bladder tumors: Determination of the risk of progression. Urologic Oncology: Seminars and Original Investigations. 2021;39(2):132.e7-132.e11.
  • 18. Divrik RT, Ahin AF, Yildirim Ü, Altok M, Zorlu F. Impact of routine second transurethral resection on the long-term outcome of patients with newly diagnosed pT1 urothelial carcinoma with respect to recurrence, progression rate, and disease-specific survival: A prospective randomised clinical trial. European Urology. 2010;58(2):185–90.
  • 19. Chang SS, Boorjian SA, Chou R, Clark PE, Daneshmand S, Konety BR, et al. Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline. Journal of Urology [Internet]. 2016;196(4):1021–9. Available from: http://dx.doi.org/10.1016/j.juro.2016.06.049
  • 20. Taoka R, Matsuoka Y, Kohashiguchi K, Miura T, Tohi Y, Miyauchi Y, et al. Impact of second transurethral resection on recurrence in patients with high-grade Ta bladder cancer. International Journal of Urology. 2020;27(12):1130–5.
There are 20 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Meftun Çulpan 0000-0001-8573-1192

Ferhat Keser 0000-0002-2803-6481

Mehmet Çağlar Çakıcı 0000-0002-0176-5887

Gokhan Atis 0000-0002-9065-6104

Asıf Yıldırım 0000-0002-3386-971X

Publication Date December 27, 2022
Submission Date June 12, 2022
Acceptance Date September 12, 2022
Published in Issue Year 2022 Volume: 19 Issue: 3

Cite

Vancouver Çulpan M, Keser F, Çakıcı MÇ, Atis G, Yıldırım A. Yüksek Dereceli pTa Mesane Kanserinde Onkolojik Sonuçlar. Harran Üniversitesi Tıp Fakültesi Dergisi. 2022;19(3):536-41.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty