Treatment paradigm shift may improve survival of patients with high risk superficial bladder cancer Journal Article


Authors: Raj, G. V.; Herr, H.; Serio, A. M.; Donat, S. M.; Bochner, B. H.; Vickers, A. J.; Dalbagni, G.
Article Title: Treatment paradigm shift may improve survival of patients with high risk superficial bladder cancer
Abstract: Purpose: Historically patients with recurrent T1 bladder tumors after bacillus Calmette-Guerin have been treated with bladder sparing approaches. Recently a paradigm shift has occurred since patients are increasingly offered radical cystectomy before disease progression to muscle invasion. In this study we explored the effect of this paradigm shift on progression rates and disease specific survival. Materials and Methods: The historical cohort consisted of 307 patients from 3 prospective intravesical bacillus Calmette-Guerin protocols from 1980 to 1989. An institutional review board approved review identified 589 patients treated with bacillus Calmette-Guerin in a contemporary cohort from 1992 to 2004. Results: In the historical cohort the 85 patients with documented T1 recurrence were initially treated with repeat transurethral resection and intravesical bacillus Calmette-Guerin. Of these 85 patients 60 had progression to muscle invasive disease. At 5 years after T1 recurrence, the cumulative incidence of progression to T2 disease was 71% (95% CI 61%, 81%) and the cumulative incidence of death from disease was 48% (95% CI 39%, 60%). In the contemporary cohort 129 patients had documented T1 recurrence. In this cohort 65 of the 129 patients with recurrent T1 underwent immediate radical cystectomy. At 5 years after T1 recurrence, the cumulative incidence of progression to muscle invasive disease was 28% (95% CI 20%, 38%) and the cumulative incidence of death from disease was 31% (95% CI 22%, 42%). Conclusions: Preemptive radical cystectomy performed for recurrent T1 disease following intravesical bacillus Calmette-Guerin therapy may be associated with better disease specific survival. © 2007 American Urological Association.
Keywords: adult; cancer survival; treatment outcome; aged; middle aged; survival rate; major clinical study; cancer recurrence; cancer growth; drug efficacy; cancer patient; outcome assessment; recurrent cancer; bcg vaccine; cohort studies; cohort analysis; risk factors; bladder cancer; urinary bladder neoplasms; high risk patient; time factors; cancer invasion; confidence interval; disease progression; cystectomy; mycobacterium bovis; neoplasm invasiveness; adjuvants, immunologic; transitional cell carcinoma; muscle metastasis; superficial cancer
Journal Title: Journal of Urology
Volume: 177
Issue: 4
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2007-04-01
Start Page: 1283
End Page: 1286
Language: English
DOI: 10.1016/j.juro.2006.11.090
PUBMED: 17382713
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 38" - "Export Date: 17 November 2011" - "CODEN: JOURA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Ganesh Raj
    20 Raj
  2. Guido Dalbagni
    256 Dalbagni
  3. Sherri M Donat
    135 Donat
  4. Andrew J Vickers
    571 Vickers
  5. Angel M Cronin
    145 Cronin
  6. Bernard Bochner
    330 Bochner
  7. Harry W Herr
    412 Herr