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Non-muscle-invasive bladder cancer (NMIBC) is the most common stage of bladder cancer.Although it is the early stage of the malignancy,the diversity of tumor biological behavior and prognosis leads to underdiagnosis and inadequate treatment of the disease.To state the present modality of management of NMIBC,we review the database of Chinese Bladder Cancer Consortium (CBCC) and synthesis updated evidence in NMIBC.
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Objective@#To explore the prognostic value of serum paraoxonase-1(PON-1) in patients with non-muscle-invasive bladder cancer.@*Methods@#Serum levels of paraoxonase-1 (PON-1) in one hundred and twenty non-muscle-invasive bladder cancer patients (bladder cancer group) and fifty healthy controls (healthy control group) in Hankou Hospital of Wuhan were detected using spectrophotometric rate assay with p-nitrophenol as the substrate. The overall survival and disease-free survival curve was drawn by Kaplan-Meier method in different serum PON-1 levels, and independent prognostic factors were analyzed by Cox proportional hazards model.@*Results@#The serum levels of PON-1 in bladder cancer group was (116.52 ± 21.91) U/L, in healthy control group was (237.96 ± 46.97) U/L, and there was significant difference (t=23.004, P < 0.01). The patients in bladder cancer group were divided into high PON-1 group (≥ 116.52 U/L, 64 patients) and low PON-1 group (< 116.52 U/L, 56 patients) by the median of PON-1(116.52 U/L). Serum PON-1 levels were closely correlated with age of bladder cancer patients (P < 0.05), but not correlated with gender, Karnofsky score, anesthesia risk grading(ASA grade), tumor multiplicity, T stage, pathological grade and tumor size (P > 0.05). The median over-all survival time of the high PON-1 group was 62 months, and 52 months in the low PON-1 group, and there was significant difference (Log-rank=7.004, P=0.008). The median disease-free survival time of the high PON-1 group was 57 months, and 49 months in the low PON-1 group, and there was significant difference (Log-rank=4.068, P=0.044). Cox multivariate regression analysis showed that T stage, serum PON-1 levels was independently associated with overall survival and disease-free survival of patients with non-muscle invasive bladder cancer (P < 0.05).@*Conclusions@#Serum PON-1 levels is increased in non-muscle invasive bladder cancer patients, and PON-1 is an independent prognostic indicator of overall survival and disease-free survival in patients with bladder cancer.
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Background: Transurethral resection of tumor is the main treatment of non-muscle-invasive urothelial carcinoma, but it is associated with high rate of recurrence and/or progression and this arouses the need for adjuvant therapy. Topoisomerase II (Top II), KI-67, and P53 are proliferation and cell cycle regulation markers that may predict tumor response to therapy. Aim: This study aimed to assess Top II, KI-67, and P53 expression and their effect on clinical outcome and response to therapy of non-muscle-invasive urothelial carcinoma. Materials and Methods: Fifty cases of non-muscle invasive urothelial carcinoma were collected; Top II, KI-67, and P53 expression was evaluated. Patients received treatment then tumor recurrence was correlated with the expression of previous markers. Results: There was a significant association between high Top II score, P53, and KI-67 and high tumor grade (P = 0.0001, 0.001, and 0.0001), submucosal infiltration (P = 0.0001 and 0.01), and recurrence (P = 0.01, 0.001, and 0.001). Conclusion: Top II, P53, and KI-67 may predict tumor response to therapy and the clinical outcome in non-muscle-invasive urothelial carcinoma.
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Bladder cancer is the most common malignant solid tumor in urinary system. More than 75% cases of bladder cancer have been diagnosed as non-muscle-invasive bladder cancer ( NMIBC ) . Transurethral resection of bladder tumor ( TURBT ) is the standard method for the diagnosis and treatment for bladder cancer, however, due to its problem of recurrence, adjuvant intravesical therapy with either immunotherapy or chemotherapy has been used to reduce recurrence and achieve better efficacy for the patients in appropriate stages. The review focused on current progress in chemotherapy agents, targeted bladder drug delivery systems and treat-ment strategies for NMIBC, which would provide guidance for clinical intravesical chemotherapy.
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Objective:To assess the accuracy of the European Organization of Research and Treatment of Cancer (EORTC) Risk Tables in predicting the prognosis of patients with T1 non-muscle-invasive bladder cancer (NMIBC) treated in the Tianjin Medical University Can-cer Institute and Hospital (TMUCIH). The prognostic factors of T1 NMIBC are also explored, and a new risk scoring model suitable for T1 NMIBC is determined. Methods:We retrospectively reviewed the clinicopathologic characteristics of 108 patients with T1 NMIBC who underwent transurethral resections in TMUCIH from January 2011 to June 2013. We scored patients based on the number of ad-verse factors. Afterwards, divided them into different risk groups by the limits determined using receiver operating characteristic curve (ROC) analysis, and created a new risk scoring model. Results:In a group of 108 patients, 90 (83%) were male and 18 were female (17%). The median age was 65 years old (ranging from 24 to 88). Furthermore, 21 patients (19.4%) had a recurrence and 11 cases (10.2%) progressed to muscle-invasive disease. Conclusion:The EORTC cannot accurately predict the recurrence and progressive rate of T1 NMIBC. The most important prognostic factors for recurrence were tumor size and prior recurrence rate. Tumor grade and prior recurrence rate are independent prognostic factors for tumor progression. The new risk scoring model is more accurate in predicting the recurrence risk and progression of T1 NMIBC.
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Objective: To evaluate the feasibility and safety of en bloc transurethral resection with thulium (Tm):-Yag laser in the management of patients with non-muscle-invasive bladder cancer. Methods: The data of 287 consecutive patents pathologically identified of non-muscle-invasive bladder cancer, who underwent transurethral resection from January 2008 to December 2013, were retrospectively analyzed. Of these patients, 209 patients underwent the traditional transurethral resection of bladder cancer (TURBT), and the other 78 patients underwent the en bloc transurethral resection with Tm-Yag laser. The operative time, intraoperative blood loss, days for urethral catheterization, duration of hospitalization after surgery, incidence of postoperative complications, detection rate of muscle layer in postoperative pathologic examination, pathologic grade and stage, and recurrence between the two groups were compared. All the patients were followed-up, and the median follow-up time was 27 months. Results: The operative time in Tm-Yag laser group was significantly longer than that in TURBT group (75.77±52.19 min vs 47.18±35.77 min, P 0.05). The incidence of postoperative complications in Tm-Yag laser group was lower than that in TURBT group (6.4% vs 1 7.7%, P = 0.045). In Tm-Yag laser group, the number of stage Tl tumors and the detection rate of muscle layer in postoperative pathologic examination were both higher than those in TURBT group (P = 0.039; P = 0.001). The total rate of tumor recurrence and progression showed no differences between the two groups (35.9% vs 43.5%, P > 0.05; 11.5% vs 14.8%, P > 0.05). The Kaplan-Meier survival curves of recurrence-free survival and progression-free survival also showed no significant differences (both P > 0.05). Conclusion: The en bloc transurethral resection with Tm-Yag laser is feasible and safe in the management of non-muscle-invasive bladder cancer.
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PURPOSE: The purpose of this study was to assess the correlation of previous bladder cancer history with the recurrence and progression of patients with high-risk non-muscle-invasive bladder cancer treated with adjuvant Bacillus Calmette-Guerin (BCG) and to evaluate their natural history. MATERIALS AND METHODS: Patients were divided into two groups based on the existence of previous bladder cancer (primary, non-primary). A logistic regression analysis was used to identify the possible differences in the probabilities of recurrence and progression with respect to tumor history, while potential differences due to gender, tumor size (> 3 cm, < 3 cm), stage (pTa, T1), concomitant carcinoma in situ (pTis) and number of tumors (single, multiple) were also assessed. Univariate and multivariate models were employed. In addition, Kaplan-Meier survival analysis was used to compare recurrence- and progression-free survival between the groups. RESULTS: A total of 192 patients were included (144 with primary and 48 with non-primary tumors). The rates of recurrence and progression for patients with primary tumors were 27.8% and 12.5%, respectively. The corresponding percentages for patients with non-primary tumors were 77.1% and 33.3%, respectively. The latter group of patients displayed significantly higher probabilities of recurrence (p=0.000; 95% confidence interval [CI], 4.067 to 18.804) and progression (p=0.002; 95% CI, 1.609 to 7.614) in a univariate logistic regression analysis. Previous bladder cancer history remained significant in the multivariate model accounting for history, age, gender, tumor size , number of tumors, stage and concomitant pTis (p=0.000; 95% CI, 4.367 to 21.924 and p=0.002; 95% CI, 1.611 to 8.182 for recurrence and progression respectively). Kaplan-Meier curves revealed that the non-primary group hadreduced progression- and recurrence-free survival. CONCLUSION: Previous non-muscle-invasive bladder cancer history correlates significantly with recurrence and progression in patients with high-risk non-muscle-invasive disease treated with adjuvant BCG.
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Humanos , Bacillus , Carcinoma in Situ , Progressão da Doença , Intervalo Livre de Doença , Modelos Logísticos , Mycobacterium bovis , História Natural , Recidiva , Neoplasias da Bexiga UrináriaRESUMO
Objective To evaluate the safety of simultaneous transurethral green laser vaporization therapy in benign prostatic hyperplasia (BPH) and nonmuscle-invasive bladder transitional cell carcinoma (NMIBT).Methods The clinical data of 27 patients (observation group) who had undergone simultaneous transurethral green laser vaporization therapy in BPH and NMIBT between May 2004 and October 2010 were analyzed retrospectively.Meanwhile 27 patients(control group) only had undergone green laser vaporization therapy in NMIBT during the same period were selected.Clinicopathologic parameters,rate of recurrence and progression,rate of recurrence in the bladder neck and prostatic urethra were determined and compared.Results The time of follow-up in observation group and control group were (28.61 ± 19.53) and (30.20 ± 21.46) months.The rates of recurrence,progression and recurrence in the bladder neck and prostatic urethra between observation group and control group had no significant differences [ 18.5％ (5/27) vs.25.9％ (7/27),3.7％ (1/27) vs.0,0 vs.0] (P ＞0.05).Conclusion Simultaneous transurethral green laser vaporization of NMIBT and BPH can be safely performed without increasing the risk of tumor recurrence in the prostatic urethra.