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Bladder Wash Cytology at Diagnosis of Ta-T1 Bladder Cancer Is Predictive for Recurrence and Progression
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Health and Developmental Care, Regional Cancer Centre.
County Hospital, Helsingborg, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
2012 (English)In: Urology, ISSN 0090-4295, E-ISSN 1527-9995, Vol. 80, no 3, 625-631 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE To evaluate the effect of the bladder wash cytology finding at the primary diagnosis of Stage Ta-T1 urinary bladder cancer on recurrence and progression. less thanbrgreater than less thanbrgreater thanMETHODS The clinical and pathologic characteristics of all patients with primary Stage Ta-T1 urinary bladder cancer were prospectively registered. The data were divided according to the bladder wash cytology results at diagnosis. Multivariate analyses were performed to determine the influence of bladder wash cytology on recurrence and progression. less thanbrgreater than less thanbrgreater thanRESULTS The analysis included 768 evaluable patients with a mean follow-up of 60 months. Recurrence was observed in 478 patients (62%) and progression in 71 (9%). High-grade malignant bladder wash cytology was predictive for recurrence and progression (P andlt; .001 and P = .036, respectively). Other factors affecting recurrence were missing bladder wash cytology data, tumors size 16-30 mm and andgt;30 mm, Stage T1 tumor category, and multiplicity (P = .008, P = .006, P andlt; .001, P = .002, and P andlt; .001, respectively). Progression was also associated with T1 tumor category, local recurrence, and primary concomitant carcinoma in situ (P andlt; .001, P andlt; .001, and P = .024, respectively). less thanbrgreater than less thanbrgreater thanCONCLUSION High-grade malignant bladder wash cytology at the primary diagnosis was predictive for recurrence and progression. This could be taken into account in designing future follow-up schedules.

Place, publisher, year, edition, pages
Elsevier , 2012. Vol. 80, no 3, 625-631 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-82061DOI: 10.1016/j.urology.2012.04.049ISI: 000308373000035OAI: oai:DiVA.org:liu-82061DiVA: diva2:557986
Available from: 2012-10-01 Created: 2012-09-28 Last updated: 2017-12-07
In thesis
1. Aspects of Recurrence and Progression in Ta/T1 Urinary Bladder Cancer
Open this publication in new window or tab >>Aspects of Recurrence and Progression in Ta/T1 Urinary Bladder Cancer
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims: To evaluate different aspects of recurrence and, when appropriate, progression in primary Ta/T1 urinary bladder cancer.

Patients and methods: All evaluable patients diagnosed with primary Ta/T1 urinary bladder cancer in Linköping and Norrköping between 1992 and 2007 were included prospectively in the study cohort. Histopathology results were classified according to the TNM system and were reviewed by a reference pathologist using the WHO 1999 criteria (except in the studies reported in Papers I and IV). Risk factors for local recurrence were evaluated using data from the period 1992–2001 (Paper I). Tumour size (Paper II) and bladder wash cytology (Paper III) at primary diagnosis were assessed regarding the impact on recurrence and progression, and tumour presence in the marginal resection in primary and recurrent Ta/T1 bladder cancer was investigated considering effects on recurrence in patients treated between 2001 and 2010 (Paper IV). Furthermore, surgical experience measured as training status (resident or specialist) and surgical volume (both during the study period and lifetime) were analysed regarding their influence on recurrence and progression (Paper V).

Results: Tumour size > 30 mm (p < 0.001) and multiplicity (p = 0.021) were significantly associated with local recurrence (Paper I). Tumour sizes 16–30 mm and > 30 mm were correlated with recurrence (p = 0.003 and p < 0.001, respectively) but not with progression (Paper II). High-grade malignant bladder wash cytology proved to be predictive of both recurrence (p < 0.001) and progression (p = 0.036) as was shown in Paper III. A tumour-positive marginal resection was related to overall (p < 0.001) and local (p < 0.001) recurrence (Paper IV). Transurethral resection of bladder tumours performed by residents was associated with recurrence (p = 0.004) but not with progression. No differences in relation to either recurrence or progression were found for the surgical volume approach at the chosen cut-offs (Paper V).

Conclusions: The present studies identified new risk factors for recurrence (tumours > 15 mm, high-grade bladder wash cytology at diagnosis, tumour-positive marginal resection, and surgery performed by residents) and progression (local recurrence and high-grade malignant bladder wash cytology at diagnosis), which in the future may be integrated into follow-up schedules or risk profiles for patients with Ta/T1 urinary bladder cancer.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 81 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1344
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89146 (URN)978-91-7519-738-8 (ISBN)
Public defence
2013-03-22, Eken salen, Hälsouniversitet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-02-22 Created: 2013-02-22 Last updated: 2015-06-05Bibliographically approved

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Jancke, GeorgRosell, JohanJahnson, Staffan

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