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Bladder Cancer Could Recur despite Bladder Removal

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Key Points

  • The 5-year international study validates the use of a marker panel to predict which patients are more likely to have a cancer recurrence after bladder removal, thereby identifying those patients as good candidates for follow-up chemotherapy.
  • When controlled for pathologic factors, the number of altered biomarkers was found to be an independent predictor of recurrence and cancer-specific mortality.

Patients with advanced bladder cancers that are surgically removed might need additional therapy to prevent recurrence in certain situations, a new UT Southwestern Medical Center study suggests.

The 5-year international study led by researchers at UT Southwestern validates the use of a marker panel to predict which patients are more likely to have a recurrence of cancer after bladder removal, thereby identifying those patients as good candidates for follow-up chemotherapy.

Important Findings

The findings, published in the most recent edition of European Urology, are important because additional molecular information could help patients with bladder cancer and their physicians decide whether administering further toxic chemotherapy is worth the risk, said Yair Lotan, MD, Professor of Urology at UT Southwestern and the study’s primary investigator and first author. Dr. Lotan is also a member of the Harold C. Simmons Cancer Center.

Patients with muscle-invasive bladder cancer typically are treated by removing all or part of the bladder (a cystectomy procedure) but are infrequently given additional chemotherapy, despite an overall relapse rate of one in every three cases.

Study Details

Using five commercially available markers and the tissues of patients who had their bladders removed, UT Southwestern researchers in the Departments of Urology and Pathology and the Simmons Cancer Center monitored a group of 216 patients to track if their cancers recurred.

When controlled for pathologic factors such as stage, grade, lymphovascular invasion, lymph node status, surgical margin status, and whether the patients had already received chemotherapy, the number of altered biomarkers was found to be an independent predictor of recurrence and cancer-specific mortality, the researchers found.

“It is well known that bladder cancer tumors have certain molecular alterations, but the problem is that there has been little data regarding which patients should get additional therapy, especially if there is no radiologic or pathologic evidence that the cancer has spread beyond the bladder,” Dr. Lotan said. “This situation exists despite the fact that approximately 35% of patients treated by cystectomy develop metastatic disease and many of these individuals die of their disease.”

The investigation’s goal was to establish whether molecular markers that are involved in cell-cycle regulation and proliferation could help identify patients at higher risk for recurrence or metastasis following bladder-cancer surgery, Dr. Lotan said. The next steps will be to try to incorporate the molecular marker panel into clinical practice.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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