PMID- 19558557
OWN - NLM
STAT- MEDLINE
DCOM- 20100225
LR  - 20220408
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 105
IP  - 2
DP  - 2010 Jan
TI  - Risk factors for positive findings in patients with high-grade T1 bladder cancer 
      treated with transurethral resection of bladder tumour (TUR) and bacille 
      Calmette-Guerin therapy and the decision for a repeat TUR.
PG  - 202-7
LID - 10.1111/j.1464-410X.2009.08694.x [doi]
AB  - OBJECTIVE: To determine factors predictive of positive findings at the 3-month 
      follow-up evaluation (after transurethral resection of bladder tumour [TUR] and 
      bacille Calmette-Guerin [BCG] therapy) in patients with initial high-grade (HG)T1 
      bladder cancer, and to assess the depth of lamina propria (LP) invasion and 
      effectiveness of BCG therapy. PATIENTS AND METHODS: In all, 138 patients with 
      initial HGT1-transitional cell carcinoma (TCC) were prospectively assigned, after 
      TUR + BCG and according to depth of LP invasion, to a postBCG-TUR (T1b) or 
      cystoscopy/cytology (T1a) at 3 months. Any finding at 3 months was considered 
      positive. The predictive value of 11 clinical and pathological variables was 
      assessed by chi-squared, Mann-Whitney U and multivariate logistic regression. 
      RESULTS: Of the 138 patients (14 women, mean age 69 years), 42% had T1a and 58% 
      T1b TCC. Tumour size and carcinoma in situ (CIS) were significantly associated 
      with positive findings and present in 26% (36/138) of the patients. The 
      postBCG-TUR (T1b cases), was positive in 31% (25/80), including seven 
      infiltrating tumours. On multivariate analysis, again a tumour size of >3 cm 
      (odds ratio, OR, 7.02) and associated CIS (OR 5.4) were significantly related to 
      a positive postBCG-TUR. A secondary finding was that at 20.3 months; patients 
      with T1a TCC, who did not undergo a repeat TUR, did not have increased 
      progression; only 3% (two of 58) had progressed compared with 21% (17/80) of 
      those with T1b/c TCC (P < 0.002). CONCLUSIONS: In initial HGT1-TCC, tumour size 
      and CIS were predictive factors of positive findings at 3 months after the 
      initial TUR + BCG therapy. Patients with HGT1-TCC invading the LP (T1b TCC) had a 
      seven times higher risk of a positive repeat TUR if the initial tumour was >3 cm 
      and a five-fold increased risk if associated with CIS. The repeat TUR after BCG 
      therapy allowed confirmation of complete resection and pathological evaluation of 
      the BCG response. Although data are still preliminary, the strategy of performing 
      a repeat TUR only in cases with LP involvement, i.e. T1b TCC, did not increase 
      the risk of progression in cases with T1a TCC.
FAU - Orsola, Anna
AU  - Orsola A
AD  - Department of Urology, Hospital Vall d'Hebron, Barcelona, Spain. 
      annaorsola@hotmail.com
FAU - Cecchini, Lluis
AU  - Cecchini L
FAU - Raventos, Carles X
AU  - Raventos CX
FAU - Trilla, Enric
AU  - Trilla E
FAU - Planas, Jacques
AU  - Planas J
FAU - Landolfi, Stefania
AU  - Landolfi S
FAU - de Torres, Ines
AU  - de Torres I
FAU - Morote, Juan
AU  - Morote J
LA  - eng
PT  - Journal Article
DEP - 20090624
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
RN  - 0 (Antineoplastic Agents)
RN  - 0 (BCG Vaccine)
SB  - IM
MH  - Administration, Intravesical
MH  - Aged
MH  - Antineoplastic Agents/*therapeutic use
MH  - BCG Vaccine/*therapeutic use
MH  - Carcinoma, Transitional Cell/*drug therapy/pathology/*surgery
MH  - Combined Modality Therapy
MH  - Cystoscopy/methods
MH  - Epidemiologic Methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Neoplasm Metastasis
MH  - Prognosis
MH  - Reoperation
MH  - Risk Factors
MH  - Treatment Outcome
MH  - Urinary Bladder Neoplasms/*drug therapy/pathology/*surgery
EDAT- 2009/06/30 09:00
MHDA- 2010/02/26 06:00
CRDT- 2009/06/30 09:00
PHST- 2009/06/30 09:00 [entrez]
PHST- 2009/06/30 09:00 [pubmed]
PHST- 2010/02/26 06:00 [medline]
AID - BJU8694 [pii]
AID - 10.1111/j.1464-410X.2009.08694.x [doi]
PST - ppublish
SO  - BJU Int. 2010 Jan;105(2):202-7. doi: 10.1111/j.1464-410X.2009.08694.x. Epub 2009 
      Jun 24.