The increasing use of intravesical therapies for stage T1 bladder cancer coincides with decreasing survival after cystectomy
| Autor: | Phillip M. Pierorazio, Carl A. Olsson, James M. McKiernan, Erica H. Lambert, Steven Poon, Mitchell C. Benson |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Male medicine.medical_specialty Urology Urinary system medicine.medical_treatment Antineoplastic Agents Cystectomy Disease-Free Survival Adjuvants Immunologic Risk Factors medicine Carcinoma Humans Survival analysis Aged Neoplasm Staging Retrospective Studies Aged 80 and over Carcinoma Transitional Cell Bladder cancer Urinary bladder business.industry Retrospective cohort study Middle Aged Prognosis medicine.disease Survival Analysis Administration Intravesical Transitional cell carcinoma medicine.anatomical_structure Urinary Bladder Neoplasms BCG Vaccine Female Neoplasm Recurrence Local business |
| Zdroj: | BJU International. 100:33-36 |
| ISSN: | 1464-410X 1464-4096 |
| DOI: | 10.1111/j.1464-410x.2007.06912.x |
| Popis: | OBJECTIVE Intravesical therapy (IVT), chemo and immunotherapy, has made conservative, bladder-sparing strategies a viable option for managing patients with high grade T1 bladder cancer. However, many of these patients will have recurrence and occasionally progression, questioning delayed intervention. This study examines the patterns of use of IVT in high-grade T1 bladder cancer and the subsequent impact on survival for patients ultimately proceeding to radical cystectomy (RC). PATIENTS AND METHODS Between 1990 and 2005, 104 patients were identified with T1 high-grade transitional cell carcinoma (TCC) and who underwent RC. Patients were divided into two groups; those having RC before 1998 (median year of surgery) and those after 1998. Trends in time from diagnosis to RC, courses of IVT, recurrence and pathological stage were analysed using two-sample t-tests with 95% confidence intervals. Kaplan–Meier analysis was used to determine the disease-free and overall survival rates. RESULTS Before 1998, 28 of 38 patients (74%) proceeded directly to RC with no IVT, vs 20 of 47 (43%) after 1998 (P = 0.004). The mean number of IVT courses per patient was 0.53 before 1998 and 1.2 afterward (P = 0.016). Patients who had RC before 1998 had a 69.7% disease-free survival at 5 years, vs 39.6% for those after 1998 (P = 0.05). CONCLUSION In the past 15 years, our experience indicates that patients having RC for T1 high-grade TCC after 1998 were more likely to receive IVT. These same patients had a worsening disease-free survival. In very few other cancers has disease-free survival decreased over time. We postulate that the decrease in survival might be related to an increased use of IVT. |
| Databáze: | OpenAIRE |
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