Oncological long-term outcomes of patients under active surveillance for low-grade bladder tumors: An update from the Bladder Cancer Italian Active Surveillance (BIAS) project

You have accessJournal of UrologyBladder Cancer: Non-invasive III (PD63)1 Sep 2021PD63-05 ONCOLOGICAL LONG-TERM OUTCOMES OF PATIENTS UNDER ACTIVE SURVEILLANCE FOR LOW-GRADE BLADDER TUMORS: AN UPDATE FROM BLADDER CANCER ITALIAN ACTIVE SURVEILLANCE (BIAS) PROJECT Roberto Contieri, Nicola Frego, Marco Paciotti, Pietro Diana, Pier Paolo Avolio, Alessandro Uleri, Davide Maffei, Vittorio Fasulo, Massimo Lazzeri, Alberto Saita, Nicolò Maria Buffi, Giovanni Lughezzani, Paolo Casale, Giorgio Guazzoni, and Rodolfo Hurle Roberto ContieriRoberto Contieri More articles by this author , Nicola FregoNicola Frego More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Pietro DianaPietro Diana More articles by this author , Pier Paolo AvolioPier Paolo Avolio More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Paolo CasalePaolo Casale More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , and Rodolfo HurleRodolfo Hurle More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002107.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Natural history of Low-risk Non-Muscle-Invasive Bladder Cancers (NMIBCs) is characterized by a high recurrence rate and a very low progression rate. Active Surveillance (AS) has emerged as a validated therapeutic approach in Low-risk NMIBCs patients in order to avoid or, at least, postpone invasive surgical treatment. The aim of this study was to confirm the oncological long-term safety of AS and to present the last updated results from Bladder Cancer Italian Active Surveillance (BIAS) project. METHODS: This prospective observational cohort study started in January 2013 and it included 214 patients with pathologically confirmed NMIBC experiencing recurrence during the follow-ups and accepted AS monitoring. AS monitoring was based on the Urine Cytology (UC) and flexible in-office cystoscopy every 3 months for the first year, and every 6 months afterwards. The inclusion criteria was: history of Low Grade NMIBC (G1–2) pTa/ pT1a; number of tumors: between one to five; size of the single tumor: <1 cm; absence of gross hematuria and negative urine cytology for high-grade carcinoma. Failure was defined as reaching the exclusion criteria after being enrolled. RESULTS: The BIAS protocol included 214 patients (251 AS events), with a median age of 72 years (IQR 66-78). Most patients were male (175/214, 81.7%) and 109 (50.9%) patients were active or former smokers. After the first TUR 55 patients had received intravesical therapy with mitomycin C and 20 with BCG. The median follow-up was 38.8 months (IQR 28.6-55.5) while the median time on AS was 13 months (IQR 7-24). Pathological characteristics before entry into AS were: 196 TaG1-G2 and 17 T1aG1G2. The median interval between the primary diagnosis and AS enrolment was 36 months (IQR 16-62.5). Of 251 AS events, 130 (51.8%) were estimated to require surgical treatment, because of: increases in the size of tumors (n=51); increases in the number of tumors (n=34); increase in both the number and size (n=29); positive UC (n=11) and gross hematuria (n=3); in two cases surgery was performed due to patients request. An upstage from LG tumor to HG/CIS was found in 14 cases (11.6%), while pT2 tumor was found in 1 case (0.07%). In 25 cases (19,2%) pathological specimens from AS failures didn't show tumor. 114 patients are still under observation. CONCLUSIONS: Our study findings confirmed the oncological safety of AS which might be a reasonable strategy to avoid unnecessary TURBT in patients with small LG pTa/pT1a recurrent BC. Additional studies are required to avoid unnecessary TURB. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1139-e1140 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Contieri More articles by this author Nicola Frego More articles by this author Marco Paciotti More articles by this author Pietro Diana More articles by this author Pier Paolo Avolio More articles by this author Alessandro Uleri More articles by this author Davide Maffei More articles by this author Vittorio Fasulo More articles by this author Massimo Lazzeri More articles by this author Alberto Saita More articles by this author Nicolò Maria Buffi More articles by this author Giovanni Lughezzani More articles by this author Paolo Casale More articles by this author Giorgio Guazzoni More articles by this author Rodolfo Hurle More articles by this author Expand All Advertisement PDF downloadLoading ...