UROLOGICAL SURVEY
Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, Newling DW, Kurth K
EORTC Data Center, Brussels, Belgium
Eur Urol. 2006; 49: 466-77
OBJECTIVES: To provide tables that allow urologists to easily calculate a superficial bladder cancer patient's short- and long-term risks of recurrence and progression after transurethral resection.
METHODS: A combined analysis was carried out of individual patient data from 2596 superficial bladder cancer patients included in seven European Organization for Research and Treatment of Cancer trials.
RESULTS: A simple scoring system was derived based on six clinical and pathological factors: number of tumors, tumor size, prior recurrence rate, T category, carcinoma in situ, and grade. The probabilities of recurrence and progression at one year ranged from 15% to 61% and from less than 1% to 17%, respectively. At five years, the probabilities of recurrence and progression ranged from 31% to 78% and from less than 1% to 45%.
CONCLUSIONS: With these probabilities, the urologist can discuss the different options with the patient to determine the most appropriate treatment and frequency of follow-up.
Editorial Comment
The risk of superficial bladder cancer to recur or to progress is relatively well known. But how high is this risk exactly? Which factors contribute to recurrence, and, more importantly, to progression? How can the risks for an individual patient be calculated according to his or her individual risk factors?
Clearly, the urologist would like to have nomograms at hand to help with these tasks similar to the well-known Partin tables for prostate cancer.
This hope became reality with the important work from Sylvester and coworkers. From the large database of the EORTC study group they calculated risk factors for superficial bladder cancer and created a model where the risk factors were evaluated in uni- and multivariate statistics. A scoring system helps to assess the probability of an individual patient for recurrence and progression. Interestingly, with regard to progression the recurrence status at the first follow-up cystoscopy is (next to CIS status) of prognostic importance. Only 8.7% of patients without a 3 month's recurrence progressed, whereas 25.6% with a recurrence at 3 months suffered later progression.
This paper is highly recommended reading for every urologist dealing with urothelial cancer.
Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
Prevention of bladder cancer: a review
Leppert JT, Shvarts O, Kawaoka K, Lieberman R, Belldegrun AS, Pantuck AJ
Department of Urology, David Geffen School of Medicine at UCLA, USA
Eur Urol. 2006; 49: 226-34
INTRODUCTION: Bladder cancer represents an ideal tumor model to test and apply cancer prevention strategies. In addition to reviewing the epidemiology of transitional cell carcinoma (TCC), we review the current status and the future directions of bladder cancer prevention.
MATERIALS AND METHODS: A literature review of peer-reviewed articles which address bladder cancer prevention was performed.
RESULTS: Pre-clinical and limited clinical data suggest that bladder cancer is responsive to efforts to delay or prevent its development in at-risk patients, and in reducing the risk of recurrence in patients with established disease. Many epidemiologic studies, however, investigating natural products, such as vitamins and herbal compounds, lack conclusive evidence of their chemopreventive effects.
CONCLUSIONS: While many agents hold promise in the prevention of bladder cancer, none currently can be recommended as proven chemoprevention strategies. Improving the accuracy of patient risk assessment and identification of surrogate endpoint biomarkers are crucial to the testing of these strategies. Efficient study design will ensure rapid and substantial advances in the chemoprevention of bladder cancer.
Editorial Comment
Doctor, what can I do to prevent my risk of bladder cancer?
These or similar questions might not be so easily answered given the amount of conflicting data on this topic. Reading the review of Leppert and coworkers might give some help. The well-known data e.g. on smoking and occupational exposure are summarized and commented, and many new information on dietary changes (fat, soy bean, vitamins, selenium) and nonsteroidal anti-inflammatories are given. With this paper at hand, a well-founded answer to the above question is possible.
Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
Urological oncology
Publication Dates
-
Publication in this collection
01 June 2006 -
Date of issue
Feb 2006
