المؤلفون: Feifer, Andrew H., Taylor, Jennifer M., Tarin, Tatum V., Herr, Harry W. herrh@mskcc.org

المصدر: European Urology. Jun2011, Vol. 59 Issue 6, p978-984. 7p.

مصطلحات موضوعية: *BLADDER cancer treatment, *ONCOLOGIC surgery, *CANCER chemotherapy, *COMBINED modality therapy, *CANCER relapse, *CYSTOTOMY

مستخلص: Abstract: Context: The optimal treatment strategy for muscle-invasive bladder cancer remains controversial. Objective: To determine optimal combination of chemotherapy and surgery aimed at preserving survival of patients with locally advanced bladder cancer. Evidence acquisition: We performed a critical review of the published abstract and presentation literature on combined modality therapy for muscle-invasive bladder cancer. We emphasized articles of the highest scientific level, combining radical cystectomy and perioperative chemotherapy with curative intent to affect overall and disease-specific survival. Evidence synthesis: Locally invasive, regional, and occult micrometastases at the time of radical cystectomy lead to both distant and local failure, causing bladder cancer deaths. Neoadjuvant and adjuvant chemotherapy regimens have been evaluated, as well as the quality of cystectomy and pelvic lymph node dissection. Conclusions: Prospective, randomized clinical trials argue strongly for neoadjuvant cisplatin-based chemotherapy followed by high-quality cystectomy performed by an experienced surgeon operating in a high-volume center. Adjuvant chemotherapy after surgery is also effective when therapeutic doses can be given in a timely fashion. Both contribute to improved overall survival; however, many patients receive only one or none of these options, and the barriers to receiving optimal, combined, systemic therapy and surgery remain to be defined. An aging, comorbid, and often unfit population increasingly affected by bladder cancer poses significant challenges in management of individual patients. [Copyright &y& Elsevier]

المؤلفون: Feifer, Andrew H.¹, Steinberg, Jordan¹, Tanguay, Simon¹, Aprikian, Armen G.¹, Brimo, Fadi², Kassouf, Wassim¹ wassim.kassouf@muhc.mcgill.ca

المصدر: Urology. Jun2010, Vol. 75 Issue 6, p1278-1282. 5p.

مصطلحات موضوعية: *URINALYSIS, *CYTODIAGNOSIS, *HEMATURIA, *COST effectiveness, *BLADDER cancer, *CYSTOSCOPY, *UROLOGY, *SENSITIVITY & specificity (Statistics)

مستخلص: Objectives: To evaluate performance and cost-effectiveness of voided cytology in patients with pure asymptomatic microscopic hematuria (AMH). Although voided cytology has been validated for use in patients with a history of urothelial carcinoma (UC), its use in low-risk patients with AMH is controversial. Methods: A total of 200 consecutive low-risk patients (median age, 64 years) with AMH were referred to the urology clinic between 2005 and 2007. All underwent cystoscopy, upper tract imaging, and voided urinary cytology. Results of voided cytology were classified as positive, atypical, or negative. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and costs were calculated. Results: None had positive cytology, 23 (11.5%) had atypical cytology, and 177 (88.5%) had negative urinary cytology. Of 200 patients, 8 (4%) were found to have low-grade UC of bladder via cystoscopy; the cytology was negative in 4 patients and atypical in 4. Of 8, 4 were Ta and 4 were pT1 tumors. There was no upper urinary tract or renal malignancy identified. If atypical cytology was considered as positive, the sensitivity, specificity, PPV, and NPV of cytology were 50%, 90%, 17%, and 98%, respectively. If atypical cytology was considered as negative, the sensitivity, specificity, PPV, and NPV of cytology were 0%, 100%, 0%, and 96%, respectively. Cost of performing urinary cytology was estimated at $262.50 per patient. Conclusions: Although this study supports evaluating patients with AMH because a significant percentage of patients will have UC, voided urine cytology added a significant cost without any diagnostic benefit in the work-up of low-risk patients with AMH. [Copyright &y& Elsevier]

المؤلفون: Ringa, Maximiliano¹ (AUTHOR), Ali, Amna¹ (AUTHOR), Feifer, Andrew¹ (AUTHOR), Kwong, Jethro CC² (AUTHOR), Chelliahpillai, Yashan² (AUTHOR), Lee, Soominn² (AUTHOR), Al-Daqqaq, Zizo² (AUTHOR), Kim, Kellie² (AUTHOR), Kulkarni, Girish S.² (AUTHOR), Khurram, Hafsah³ (AUTHOR), Andrawes, Vereena³ (AUTHOR)

المصدر: Urologic Oncology. Mar2024:Supplement, Vol. 42, pS50-S50. 1p.

مصطلحات موضوعية: *NON-muscle invasive bladder cancer, *BLADDER cancer, *PATIENT compliance, *SOCIOECONOMIC status, *CANCER patients, *BCG immunotherapy

مصطلحات جغرافية: ONTARIO

مستخلص: The association between socioeconomic status and oncological outcomes has been described, highlighting their influence on stage at presentation, treatment patterns, and overall mortality. Nevertheless, the specific impact of socioeconomic marginalization on non-muscle invasive bladder cancer (NMIBC) outcomes remains uncertain. The Ontario Marginalization Index (ON-Marg) serves as a comprehensive tool to explore health inequality through four dimensions: residential instability, material deprivation, dependency, and ethnic concentration. This study aims to investigate the association between marginalization and NMIBC outcomes among patients treated at both community and academic centers in Ontario, a region characterized by one of the world's most diverse communities and supported by a publicly funded health care system. A retrospective chart review and analysis of 2794 patients diagnosed with NMIBC between 2005 and 2022 was conducted. Data on marginalization status, clinical and disease characteristics, treatment compliance, and oncological outcomes such as recurrence, progression, and survival were collected. Marginalization status was determined using the ON-Marg and categorized into quintiles, with higher numbers representing a greater degree of marginalization. Differences in tumor stage at diagnosis and treatment compliance were assessed using Chi-squared tests. Time-to-event analysis were assessed by Kaplan-Meier curve analysis. Patient characteristics, stratified by marginalization quintile, are summarized in Table 1. Median follow-up was 5.9 years (IQR 3.2-9.2). At diagnosis, poorer marginalization status was associated with significantly higher tumour grade (p=0.024). Patients with worse marginalization status were also less likely to receive BCG treatment when indicated (p=0.023). The overall recurrence rate was 53.6%, with evidence of a progressive but not significant increase in the incidence of recurrence and a shorter time to recurrence from the least to the most marginalized quintiles. Worse marginalization status is associated with a progression to muscle-invasive disease and overall mortality (Figure 1). Marginalized patients were more likely to present with higher grade tumours at diagnosis. Delayed presentation or other unmeasured factors may potentially contribute to this finding. Moreover, treatment compliance, especially use of BCG, was worse within more marginalized groups and may be associated with worse oncological outcomes, such as disease progression and overall mortality. The incorporation of socioeconomic status into clinical assessments can aid healthcare practitioners in identifying vulnerable patient populations and tailoring interventions to improve outcomes in NMIBC. [ABSTRACT FROM AUTHOR]

المؤلفون: Kwong, Jethro C.C.¹ (AUTHOR), Al-Daqqaq, Zizo¹ (AUTHOR), Chelliahpillai, Yashan¹ (AUTHOR), Lee, Soomin¹ (AUTHOR), Kim, Kellie¹ (AUTHOR), Chan, Amy² (AUTHOR), Kuk, Cynthia² (AUTHOR), Zlotta, Alexandre R.² (AUTHOR), Ringa, Maximiliano³ (AUTHOR), Ali, Amna³ (AUTHOR), Feifer, Andrew³ (AUTHOR), Perlis, Nathan⁴ (AUTHOR), Lee, Jason Y.⁴ (AUTHOR), Hamilton, Robert J.⁴ (AUTHOR), Fleshner, Neil E.⁴ (AUTHOR), Finelli, Antonio⁴ (AUTHOR), Kulkarni, Girish S.⁴ (AUTHOR), Johnson, Alistair E.W.⁵ (AUTHOR)

المصدر: Urologic Oncology. Mar2024:Supplement, Vol. 42, pS53-S54. 2p.

مصطلحات موضوعية: *NON-muscle invasive bladder cancer, *BLADDER cancer, *ARTIFICIAL intelligence, *TUBERCULIN test, *COHORT analysis, *DECISION making

مصطلحات جغرافية: UGANDA, MISSISSAUGA (Ont.)

مستخلص: Several tools have been developed to predict the risk of progression in non-muscle invasive bladder cancer (NMIBC). However, they do not reflect current practice and perform poorly. We aimed to develop NIMBLE, an artificial intelligence (AI)-based tool, to better predict progression in contemporarily treated NMIBC patients. In addition, we sought to externally validate NIMBLE at two community-based hospitals to assess its generalizability in non-academic settings. A retrospective, multi-institutional cohort study was performed on all NMIBC patients treated at the University Health Network, Canada from Jan-2005 to Dec-2020 (n=1173); Credit Valley Hospital, Canada from Jan-2005 to Mar-2022 (n=754); and Mississauga Hospital, Canada from Jan-2005 to Mar-2022 (n=906). Patients were excluded if they had ≥T2 disease at initial diagnosis or < 1 year of follow-up. Primary outcome was time to progression, calculated from date of initial TURBT to date of first development of ≥T2, N+, or M+ disease. NIMBLE, based on a gradient-boosted survival forest, was trained on the University Health Network cohort, and externally validated on all other institutions. NIMBLE was compared against a LASSO Cox regression model using the same variables and the EAU prognostic risk groups. Model evaluation was based on c-index, calibration, and decision curve analysis. During a median follow-up of 55 months (IQR 25-96), 419 out of 2,833 patients (15%) developed progression. Median time to progression was 16 months (IQR 6-38). NIMBLE included the following predictors: age, sex, tumour history, stage, grade (WHO 2004/2016), concomitant carcinoma-in-situ, variant histology, lymphovascular invasion, number of tumours, tumour diameter, Bacillus Calmette-Guérin, and postoperative mitomycin C. In the training cohort, NIMBLE achieved a c-index of 0.78 (95% CI 0.74-0.83), compared to 0.75 (95% CI 0.68-0.80, p<0.001) and 0.75 (95% CI 0.72-0.77, p<0.001) for the Cox model and EAU risk groups, respectively. On external validation, NIMBLE achieved a c-index of 0.80 in both community cohorts compared to 0.75-0.77 for the other models (p<0.01). NIMBLE showed reasonable calibration for predicting 10-year progression for risks between 10-50%. At 1, 5, and 10 years, NIMBLE demonstrated the highest net benefit for clinically relevant thresholds between 15-30% (Figure 1). NIMBLE performed favourably compared to contemporary prediction tools in both academic and community settings. NIMBLE may be used to support patient counselling and better inform the need for treatment escalation in patients at high risk of progression. Ongoing work is being conducted to assess the generalizability of NIMBLE in larger NMIBC cohorts. [ABSTRACT FROM AUTHOR]