Purpose This study was carried out to assess whether a prolonged time between primary transurethral resection of non-muscle-invasive bladder cancer (TURB) and implementation of bacillus Calmette-Guerin (BCG) immunotherapy (time to BCG; TTBCG) is associated with adverse oncological survival in patients with T1 high-grade (HG) non-muscle-invasive bladder cancer (NMIBC). Materials and methods Data on 429 patients from 13 tertiary care centers with primary T1HG NMIBC treated with reTURB and maintenance BCG between 2001 and 2019 were retrospectively reviewed. Change-point regression was applied following Muggeo's approach. The population was divided into subgroups according to TTBCG, whereas the recurrence-free survival (RFS) and progression-free survival (PFS) were estimated with log-rank tests. Additionally, Cox regression analyses were performed. Due to differences in baseline patient characteristics, propensity-score-matched analysis (PSM) and inverse-probability weighting (IPW) were implemented. Results The median TTBCG was 95 days (interquartile range (IQR): 71-127). The change-point regression analysis revealed a gradually increasing risk of recurrence with growing TTBCG. The risk of tumor progression gradually increased until a TTBCG of approximately 18 weeks. When the study population was divided into two subgroups (time intervals: ≤ 101 and > 101 days), statistically significant differences were found for both RFS (p = 0.029) and PFS (p = 0.005). Furthermore, in patients with a viable tumor at reTURB, there were no differences in RFS and PFS. After both PSM and IPW, statistically significant differences were found for both RFS and PFS, with worse results for longer TTBCG. Conclusion This study shows that delaying BCG immunotherapy after TURB of T1HG NMIBC is associated with an increased risk of tumor recurrence and progression.
Abstract Background Intravesical instillation of bacillus Calmette-Guerin (BCG) is an accepted strategy to prevent recurrence of non–muscle-invasive bladder cancer (NMIBC) but associated with significant toxicity. Objective NIMBUS assessed whether a reduced number of standard-dose BCG instillations are noninferior to the standard number and dose in patients with high-grade NMIBC. Design, setting, and participants A total of 345 patients from 51 sites were randomised between December 2013 and Jul...
Last. Viktor Soukup(First Faculty of Medicine, Charles University in Prague)H-Index: 16
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Abstract Context This overview presents the updated European Association of Urology (EAU) guidelines for non–muscle-invasive bladder cancer (NMIBC), TaT1, and carcinoma in situ (CIS). Objective To provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation and recommendations. Evidence acquisition A broad and comprehensive scoping exercise covering all areas of the NMIBC guidelines has been performed annually since the last published version in 201...
INTRODUCTION AND OBJECTIVES:Surgical wait times (SWT) are a major concern in healthcare, with hospitals burdened by increased demand and limited resources. In 2005, the Canadian Surgical Wait Time ...
Last. Xinghuan Wang(WHU: Wuhan University)H-Index: 43
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Background: About 75% of newly diagnosed bladder cancer cases suffer from non-muscle invasive bladder cancer (NMIBC), which used to recur and progress despite transurethral resection of bladder tumor (TURBT). This meta-analysis was conducted to examine if combined application of intravesical bacille Calmette-Guerin (BCG) with chemotherapy is associated with better prognosis. Methods: Systematic searches of randomized controlled trials (RCTs) concerning NMIBC were performed in PubMed, EMbase, CEN...
To investigate the predictors of residual tumors at repeat transurethral resection of bladder tumors (re-TURBT) for the patients with T1 bladder cancer and evaluate the effect of the residual tumors on the prognosis of the disease.We reviewed the clinical data of the patients with T1 bladder cancer who underwent re-TURBT from 2008 to 2015 in our department. Seventy-two patients received re-TURBT 2-6 weeks after the initial TURBT. A total of 65 patients were followed up, and we recorded the event...
Abstract Background There are no prognostic factor publications on stage Ta–T1 non–muscle-invasive bladder cancer (NMIBC) treated with 1–3 yr of maintenance bacillus Calmette-Guerin (BCG). Objective To determine prognostic factors in NMIBC patients treated with 1–3 yr of BCG after transurethral resection of the bladder (TURB), to derive nomograms and risk groups, and to identify high-risk patients who should be considered for early cystectomy. Design, setting, and participants Data for 1812 pati...
Propensity score weighting is one of the techniques used in controlling for selection biases in nonexperimental studies. Propensity scores can be used as weights to account for selection assignment differences between treatment and comparison groups. One of the advantages of this approach is that all the individuals in the study can be used for the outcomes evaluation. In this paper, we demonstrate how to conduct propensity score weighting using R. The purpose is to provide a stepby-step guide t...
#2Thomas W. Flaig(CU: University of Colorado Boulder)H-Index: 37
Last. John A. Taylor(UConn: University of Connecticut)H-Index: 14
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A focus group of specialized urologic oncologists has reviewed guidelines and clinical evidence and discussed their experiences regarding the optimal use of BCG in the management of patients with NIMBC. Here, they provide a review of BCG therapy, clarify complex related topics and recommend best practice guidelines to improve BCG use and patient outcomes.
#1Itay Sternberg(MSK: Memorial Sloan Kettering Cancer Center)H-Index: 9
#2Gal E. Keren Paz(MSK: Memorial Sloan Kettering Cancer Center)H-Index: 5
Last. Guido Dalbagni(MSK: Memorial Sloan Kettering Cancer Center)H-Index: 77
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Bladder cancer patients with lamina propria invasion (T1 disease) and residual T1 disease on restaging transurethral resection of bladder tumour (re-TURBT) are at a very high risk for recurrence and progression. Despite this risk, most patients are treated with a bladder preserving approach and not immediate radical cystectomy (RC). In this study we have shown that a quarter of patients with T1 bladder cancer and residual T1 on re-TURBT who are treated with immediate RC are found to have carcino...
#2Wesley Yip(SC: University of Southern California)H-Index: 3
Last. Inderbir S. Gill(SC: University of Southern California)H-Index: 135
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The purpose of the study is to evaluate the impact of a multimodal Enhanced Recovery After Surgery (ERAS) protocol on perioperative opioid consumption and hospital length of stay (LOS) after robotic-assisted radical prostatectomy (RARP). We compared the first 176 patients enrolled in the protocol (ERAS group) with the previous 176 patients (non-ERAS group) at a single quaternary institution from December 2017 to June 2019. The ERAS protocol included a multimodal opioid-sparing regimen utilizing ...
OBJECTIVE To assess the value of second-look resection (SLR) in stage T1 bladder cancer (BCa) with respect to progression-free survival (PFS), and also the secondary outcomes recurrence-free survival (RFS), bladder-cancer-specific survival (CSS), and cystectomy-free survival (CFS). PATIENTS AND METHODS The study included 2456 patients diagnosed with stage T1 BCa 2004-2009 with 5-yr follow-up registration in the nationwide Bladder Cancer Data Base Sweden (BladderBaSe). PFS, RFS, CSS, and CFS were...
