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    Improving Selection Criteria for Early Cystectomy in High-Grade T1 Bladder Cancer: A Meta-Analysis of 15,215 Patients

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    Authors
    Martin-Doyle, William
    Leow, Jeffrey J.
    Orsola, Anna
    Chang, Steven L.
    Bellmunt, Joaquim
    Student Authors
    William Martin-Doyle
    Faculty Advisor
    Joaquim Bellmunt, Judith A. Savageau
    UMass Chan Affiliations
    School of Medicine
    Document Type
    Journal Article
    Publication Date
    2015-01-05
    Keywords
    Diagnosis
    Health Services Research
    Neoplasms
    Oncology
    Surgical Procedures, Operative
    Urology
    
    Metadata
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    Link to Full Text
    http://dx.doi.org/10.1200/JCO.2014.57.6967
    Abstract
    PURPOSE: High-grade T1 (HGT1) bladder cancer is the highest risk subtype of non-muscle-invasive bladder cancer, with highly variable prognosis, poorly understood risk factors, and considerable debate about the role of early cystectomy. We aimed to address these questions through a meta-analysis of outcomes and prognostic factors. METHODS: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and American Society of Clinical Oncology abstracts were searched for cohort studies in HGT1. We pooled data on recurrence, progression, and cancer-specific survival from 73 studies. RESULTS: Five-year rates of recurrence, progression, and cancer-specific survival were 42% (95% CI, 39% to 45%), 21% (95% CI, 18% to 23%), and 87% (95% CI, 85% to 89%), respectively (56 studies, n = 15,215). In the prognostic factor meta-analysis (33 studies, n = 8,880), the highest impact risk factor was depth of invasion (T1b/c) into lamina propria (progression: hazard ratio [HR], 3.34; P < .001; cancer-specific survival: HR, 2.02; P = .001). Several other previously proposed factors also predicted progression and cancer-specific survival (lymphovascular invasion, associated carcinoma in situ, nonuse of bacillus Calmette-Guérin, tumor size > 3 cm, and older age; HRs for progression between 1.32 and 2.88, P ≤ .002; HRs for cancer-specific survival between 1.28 and 2.08, P ≤ .02). CONCLUSION: In this large analysis of outcomes and prognostic factors in HGT1 bladder cancer, deep lamina propria invasion had the largest negative impact, and other previously proposed prognostic factors were also confirmed. These factors should be used for prognostication and patient stratification in future clinical trials, and depth of invasion should be considered for inclusion in TNM staging criteria. This meta-analysis can also help define selection criteria for early cystectomy in HGT1 bladder cancer, particularly for patients with deep lamina propria invasion combined with other risk factors.
    Source
    J Clin Oncol. 2015 Jan 5. [Epub ahead of print] doi: 10.1200/JCO.2014.57.6967.
    DOI
    10.1200/JCO.2014.57.6967
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49226
    PubMed ID
    25559810
    Notes

    Medical student William Martin-Doyle participated in this study as part of the Senior Scholars research program at the University of Massachusetts Medical School.

    Related Resources
    Link to article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1200/JCO.2014.57.6967
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