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EORTC risk tables - their usefulness in the assessment of recurrence and progression risk in non-muscle-invasive bladder cancer in Polish patients.

Borkowska EM, Jędrzejczyk A, Marks P, Catto JW, Kałużewski B - Cent European J Urol (2013)

Bottom Line: We decided to check the rates of the changes mentioned above in the group of the Polish patients after a year-long observation and next to compare them with the results calculated in the European Organisation of Research and Treatment of Cancer (EORTC) risk tables.The coexisting carcinoma in situ (CIS) was observed in four cases.Partly, it could be the result of using a relatively small group of patients for observation and applying a different method of treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical and Laboratory Genetics Medical University of Łódź, Poland ; Institute for Cancer Studies and Academic Urology Unit University of Sheffield, United Kingdom.

ABSTRACT

Introduction: The assessment of risk of recurrence and progression of bladder cancer (BC) is still rather difficult. We decided to check the rates of the changes mentioned above in the group of the Polish patients after a year-long observation and next to compare them with the results calculated in the European Organisation of Research and Treatment of Cancer (EORTC) risk tables.

Methods: The tested group consisted of 91 patients who underwent transurethral resection of bladder tumour (TURBT). When being diagnosed, 60 cases were in the pTa clinical stage, whereas 30 cases were in T1. The coexisting carcinoma in situ (CIS) was observed in four cases. On the basis of the scores obtained from the EORTC tables, the patients were divided into the groups of low, intermediate or high risk of disease recurrence and progression.

Results: Recurrence was noticed in 23 patients (25%), while progression was observed in 11 patients (12.1%). The rate of the observed recurrences proved to be lower than it had been predicted in all the groups, except for one of the intermediate-risk group (score 1- 4). Moreover, the rate of the progressions predicted according to the EORTC risk tables was higher in all the risk groups.

Conclusions: It can be noticed that the rate of real recurrences is lower than expected, whereas the rate of the observed progressions is overestimated. Partly, it could be the result of using a relatively small group of patients for observation and applying a different method of treatment.

No MeSH data available.


Related in: MedlinePlus

Non–muscle invasive bladder cancer pathways adapted from World J Urol. 2011 29: 291–301. Abbreviations: BCG – bacillus calmette–guérin, CIS – carcinoma in situ, CXR – chest X–ray, INF – interferon–alpha, IVU – intravenous urogram, LUTS – lower urinary tract symptoms, LND – lymph node dissection, MIBC – muscle invasive bladder.cancer, NMIBC – non–muscle invasive bladder cancer, Prostatic TCC – transitional cell carcinoma of the prostate, TB – tuberculosis [34].
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Figure 0002: Non–muscle invasive bladder cancer pathways adapted from World J Urol. 2011 29: 291–301. Abbreviations: BCG – bacillus calmette–guérin, CIS – carcinoma in situ, CXR – chest X–ray, INF – interferon–alpha, IVU – intravenous urogram, LUTS – lower urinary tract symptoms, LND – lymph node dissection, MIBC – muscle invasive bladder.cancer, NMIBC – non–muscle invasive bladder cancer, Prostatic TCC – transitional cell carcinoma of the prostate, TB – tuberculosis [34].

Mentions: Recurrence, progression to higher clinical stages and metastases are the biggest problems related to cancers. At present, the decision about how a patient should be treated is mainly dependent on the results of histopathological tests. In 2004, the WHO proposed a new tumour grade classification. Unfortunately, the new system has been accepted despite of the lack of clinical evidence for its usefulness and proper studies with long–term follow–up to asses prognostic value and reproducibility. Therefore, according to the European Association of Urology (EAU) guidelines, both systems (the old one from 1973 and the new one from 2004) can be used in practice. It is known that the same histopathological assessment is likely to be repeated if made by the same person, but assessments sometimes tend to differ considerably when a number of people assess the same sample. The poor reproducibility of pathologic stage and grade is a recognized problem. Even in the grade case results can be different in 40–60% of cases [6, 24, 25]. Several nomograms have been estabilished to provide individualized risk assessment but the biological potential of bladder tumour is not sufficiently described by its histological classification [24]. Early recurrence is connected with a worse prognosis, which was pointed out in one of the scientific dissertations [26]. Therefore, more and more attention is given to biological markers with which there are no such big differences. Recently, there has been more and more information about biological markers which, together with the current research, would enable easier differentiation of patients for disease recurrence and progression [6, 7, 11, 12, 22, 23]. One of the study clearly demonstrated superior reproducibility of them (100%) [17]. Fibroblast growth factor receptor 3 (FGFR3) gene mutations are ones of the most frequently tested molecular biology markers in BC, in DNA taken both from tumour and from urine sediment cells. It has been shown that there is a link between these mutations in tumour and a relatively better prognosis [27, 28]. However, the information about this issue is still not very clear as the combination with a different marker showed the correlation with a worse prognosis [17]. The influence on recurrence rate is also controversial. Recent studies presented only slightly higher risk of recurrence with the presence of the mutation whereas in previous results, FGFR3 mutations was assumed to increase the recurrence rate [18, 29]. Another well tested marker are 9 chromosome deletions and loss of heterozygosity. These are mainly the changes in NMIBC and it is possible to determine their appearance both in tumour DNA and in DNA isolated from urine sediment [30, 31, 32]. They are observed even in 60% of cases (also confirmed by our earlier research) and can be used for detection and monitoring of the disease. On the other hand, a definitely negative outcome appears in the case of TP53 gene mutation [22, 33]. From our point of view, detection of these well tested markers, where correlation with the disease course was observed, should be included in the treatment plan for BC cases, as we propose in Figure 2. Costs of such analyses are currently much lower than several years ago, and certainly they are much lower than cystoscopy costs. Moreover, unlike cystoscopy, examinations carried out for urine analyses are noninvasive ones, which is an additional advantage.


EORTC risk tables - their usefulness in the assessment of recurrence and progression risk in non-muscle-invasive bladder cancer in Polish patients.

Borkowska EM, Jędrzejczyk A, Marks P, Catto JW, Kałużewski B - Cent European J Urol (2013)

Non–muscle invasive bladder cancer pathways adapted from World J Urol. 2011 29: 291–301. Abbreviations: BCG – bacillus calmette–guérin, CIS – carcinoma in situ, CXR – chest X–ray, INF – interferon–alpha, IVU – intravenous urogram, LUTS – lower urinary tract symptoms, LND – lymph node dissection, MIBC – muscle invasive bladder.cancer, NMIBC – non–muscle invasive bladder cancer, Prostatic TCC – transitional cell carcinoma of the prostate, TB – tuberculosis [34].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921849&req=5

Figure 0002: Non–muscle invasive bladder cancer pathways adapted from World J Urol. 2011 29: 291–301. Abbreviations: BCG – bacillus calmette–guérin, CIS – carcinoma in situ, CXR – chest X–ray, INF – interferon–alpha, IVU – intravenous urogram, LUTS – lower urinary tract symptoms, LND – lymph node dissection, MIBC – muscle invasive bladder.cancer, NMIBC – non–muscle invasive bladder cancer, Prostatic TCC – transitional cell carcinoma of the prostate, TB – tuberculosis [34].
Mentions: Recurrence, progression to higher clinical stages and metastases are the biggest problems related to cancers. At present, the decision about how a patient should be treated is mainly dependent on the results of histopathological tests. In 2004, the WHO proposed a new tumour grade classification. Unfortunately, the new system has been accepted despite of the lack of clinical evidence for its usefulness and proper studies with long–term follow–up to asses prognostic value and reproducibility. Therefore, according to the European Association of Urology (EAU) guidelines, both systems (the old one from 1973 and the new one from 2004) can be used in practice. It is known that the same histopathological assessment is likely to be repeated if made by the same person, but assessments sometimes tend to differ considerably when a number of people assess the same sample. The poor reproducibility of pathologic stage and grade is a recognized problem. Even in the grade case results can be different in 40–60% of cases [6, 24, 25]. Several nomograms have been estabilished to provide individualized risk assessment but the biological potential of bladder tumour is not sufficiently described by its histological classification [24]. Early recurrence is connected with a worse prognosis, which was pointed out in one of the scientific dissertations [26]. Therefore, more and more attention is given to biological markers with which there are no such big differences. Recently, there has been more and more information about biological markers which, together with the current research, would enable easier differentiation of patients for disease recurrence and progression [6, 7, 11, 12, 22, 23]. One of the study clearly demonstrated superior reproducibility of them (100%) [17]. Fibroblast growth factor receptor 3 (FGFR3) gene mutations are ones of the most frequently tested molecular biology markers in BC, in DNA taken both from tumour and from urine sediment cells. It has been shown that there is a link between these mutations in tumour and a relatively better prognosis [27, 28]. However, the information about this issue is still not very clear as the combination with a different marker showed the correlation with a worse prognosis [17]. The influence on recurrence rate is also controversial. Recent studies presented only slightly higher risk of recurrence with the presence of the mutation whereas in previous results, FGFR3 mutations was assumed to increase the recurrence rate [18, 29]. Another well tested marker are 9 chromosome deletions and loss of heterozygosity. These are mainly the changes in NMIBC and it is possible to determine their appearance both in tumour DNA and in DNA isolated from urine sediment [30, 31, 32]. They are observed even in 60% of cases (also confirmed by our earlier research) and can be used for detection and monitoring of the disease. On the other hand, a definitely negative outcome appears in the case of TP53 gene mutation [22, 33]. From our point of view, detection of these well tested markers, where correlation with the disease course was observed, should be included in the treatment plan for BC cases, as we propose in Figure 2. Costs of such analyses are currently much lower than several years ago, and certainly they are much lower than cystoscopy costs. Moreover, unlike cystoscopy, examinations carried out for urine analyses are noninvasive ones, which is an additional advantage.

Bottom Line: We decided to check the rates of the changes mentioned above in the group of the Polish patients after a year-long observation and next to compare them with the results calculated in the European Organisation of Research and Treatment of Cancer (EORTC) risk tables.The coexisting carcinoma in situ (CIS) was observed in four cases.Partly, it could be the result of using a relatively small group of patients for observation and applying a different method of treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical and Laboratory Genetics Medical University of Łódź, Poland ; Institute for Cancer Studies and Academic Urology Unit University of Sheffield, United Kingdom.

ABSTRACT

Introduction: The assessment of risk of recurrence and progression of bladder cancer (BC) is still rather difficult. We decided to check the rates of the changes mentioned above in the group of the Polish patients after a year-long observation and next to compare them with the results calculated in the European Organisation of Research and Treatment of Cancer (EORTC) risk tables.

Methods: The tested group consisted of 91 patients who underwent transurethral resection of bladder tumour (TURBT). When being diagnosed, 60 cases were in the pTa clinical stage, whereas 30 cases were in T1. The coexisting carcinoma in situ (CIS) was observed in four cases. On the basis of the scores obtained from the EORTC tables, the patients were divided into the groups of low, intermediate or high risk of disease recurrence and progression.

Results: Recurrence was noticed in 23 patients (25%), while progression was observed in 11 patients (12.1%). The rate of the observed recurrences proved to be lower than it had been predicted in all the groups, except for one of the intermediate-risk group (score 1- 4). Moreover, the rate of the progressions predicted according to the EORTC risk tables was higher in all the risk groups.

Conclusions: It can be noticed that the rate of real recurrences is lower than expected, whereas the rate of the observed progressions is overestimated. Partly, it could be the result of using a relatively small group of patients for observation and applying a different method of treatment.

No MeSH data available.


Related in: MedlinePlus