%0 Journal Article
%T Cistectom¨ªa radical en tumores vesicales no m¨²sculo-infiltrantes que fracasan al tratamiento con bacilo de Calmette-Gu¨¦rin
%A Huguet
%A J.
%A Gaya
%A J.M.
%A Sabat¨¦
%A S.
%A Palou
%A J.
%A Villavicencio
%A H.
%J Actas Urol¨®gicas Espa£¿olas
%D 2010
%I Scientific Electronic Library Online
%R 10.4321/S0210-48062010000100011
%X objective: to assess the characteristics and outcomes of patients with non-muscle invasive bladder cancer (nmibc) undergoing radical cystectomy (rc) due to bcg failure. materials and methods: ninety-five (11%) of the 864 patients undergoing radical cystectomy (rc) at our center from 1989 to 2002 had received prior treatment with bcg. of these, 62 (65.2%) underwent rc due to relapsing, high-risk nmibc or cis despite bcg therapy. a stage > pt2 tumor was reported in the cystectomy specimen in 17 (27%) of these patients, who were considered to have been understaged. rc was performed for clinical progression in 33 patients (34.7%). their last transurethral resection before rc showed invasive disease. a retrospective analysis was made of the outcomes of patients who underwent rc for bcg failure and the clinical and pathological differences between understaged patients and those with clinical progression. results: five-year css was 90% in 45 patients with clinical and pathological nmibc and 50.6% in 50 patients with progression to muscle-infiltrating disease (clinical progresion and understaged) (p < 0,05). there were no differences in survival in patients with clinical progresion as compared to understaged patients. median time from tumor diagnosis to tumor progresion was 24 months (10th-90th percentile, 6-98 months). patients with clinical progresion had significantly more t1 tumors (p = 0.015) in tur before progression and more pt3 tumors (p < 0.01) in the rc specimen. understaged patients more often had pathological pt4 stages (p < 0.02). conclusion: in patients with high-risk nmibcs who fail bcg therapy, rc should be performed before progression because survival is decreased when the rc specimen shows muscle-invasive disease. high-grade t1 tumors are responsible for most early clinical progressions. patients with nmibc may have subclinical progression, mainly within the prostate.
%K bcg
%K bladder cancer
%K cystectomy.
%U http://scielo.isciii.es/scielo.php?script=sci_abstract&pid=S0210-48062010000100011&lng=en&nrm=iso&tlng=en