| 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 70(1):7-30, 2020 01. |
Review/Other-Dx |
N/A |
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data. |
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers. |
4 |
| 2. Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017. |
Review/Other-Dx |
N/A |
To classify patients with cancer, define prognosis, and determine the best treatment approaches. |
No abstract available. |
4 |
| 3. Expert Panel on Urologic Imaging:, van der Pol CB, Sahni VA, et al. ACR Appropriateness Criteria R Pretreatment Staging of Muscle-Invasive Bladder Cancer. J. Am. Coll. Radiol.. 15(5S):S150-S159, 2018 May. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for pretreatment staging of muscle-invasive bladder cancer. |
No results stated in abstract. |
4 |
| 4. Chang SS, Boorjian SA, Chou R, et al. Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline. J Urol. 196(4):1021-9, 2016 Oct. |
Review/Other-Tx |
N/A |
To provide a clinical framework for the management of non-muscle invasive bladder cancer (NMIBC) |
A risk-stratified approach categorizes patients into broad groups of low-, intermediate-, and high-risk. Importantly, the evaluation and treatment algorithm takes into account tumor characteristics and uniquely considers a patient’s response to therapy. The 38 statements vary in level of evidence, but none include Grade A evidence, and many were Grade C. |
4 |
| 5. Kim HS, Ku JH, Kim SJ, et al. Prognostic Factors for Recurrence and Progression in Korean Non-Muscle-Invasive Bladder Cancer Patients: A Retrospective, Multi-Institutional Study. Yonsei Med J. 57(4):855-64, 2016 Jul. |
Observational-Dx |
2412 patients |
To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasivebladder cancer (NMIBC). |
With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence- free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy. |
3 |
| 6. Liu S, Hou J, Zhang H, et al. The evaluation of the risk factors for non-muscle invasive bladder cancer (NMIBC) recurrence after transurethral resection (TURBt) in Chinese population. PLoS ONE. 10(4):e0123617, 2015. |
Observational-Dx |
698 patients |
To evaluate the potential risk factors of bladder cancer recurrence after transurethral resection of bladder based on a Chinese population. |
A total of 583 males (83.5%) and 115 females (16.5%) were enrolled in our study. The median follow-up duration was 51.5 months. Gender, chief complain, tumor size, number of lesions, histological grade and chemotherapeutic agents were found significantly associated with patients’ short-term recurrence (less than 1 year) (All p<0.05). In the multivariate analysis, tumor size, number of lesions, histological grade and chemotherapeutic agents were significantly related to patients’ short-term recurrence (less than 1 year) (All p<0.05). A multivariate model based on tumor size, number of lesions, histological grade and chemotherapeuticagents had an AUC of 0.697, which significantly improved the prediction utility for bladder cancer short-term recurrence (less than 1 year) than any single factor In the multivariate Cox regression, tumor size greater than 3 cm, multifocal lesions, worsen histological grade and non-urothelial carcinoma was related to time to recurrence (TR). |
3 |
| 7. Zachos I, Tzortzis V, Mitrakas L, et al. Tumor size and T stage correlate independently with recurrence and progression in high-risk non-muscle-invasive bladder cancer patients treated with adjuvant BCG. Tumour Biol. 35(5):4185-9, 2014 May. |
Observational-Dx |
144 patients |
To determine the prognostic significance of age, gender, associated carcinoma in situ, stage, number of tumors, and tumor size for patients with high-risk non-muscle-invasive bladder tumors treated with bacillus Calmette-Guerin (BCG). |
Patients were categorized into two groups: group A, complete responders without recurrence and without progression, and group B, patients with recurrence and with progression. Furthermore, group B was divided into two subgroups: group B1, patients with recurrence, and group B2, patients with progression. Univariate analysis of group B showed that only tumor size of >3 cm diameter (hazard ratio (HR) 11.99; 95% confidence interval (CI) range 5.69-25.3; p?<?0.001) is associated with recurrence. After multivariate analysis, the same factor appeared to be prognostic for recurrence as well. In addition, group B2 was statistically correlated with group B1. Univariate analysis proved that tumor stage (Ta or T1) is the unique factor associated with progression (HR 6.4; 95% CI 1.29-31.9; p?=?0.02). Tumor stage seems to be associated with disease's progression after the multivariate analysis too. |
3 |
| 8. Lammers RJ, Hendriks JC, Rodriguez Faba OR, Witjes WP, Palou J, Witjes JA. Prediction model for recurrence probabilities after intravesical chemotherapy in patients with intermediate-risk non-muscle-invasive bladder cancer, including external validation. World J Urol. 34(2):173-80, 2016 Feb. |
Observational-Dx |
724 patients |
To develop a model to predict recurrence for patients with intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC) treated with intravesical chemotherapy which can be challenging because of the heterogeneous characteristics of these patients. |
A total of 724 patients were available for analyses, of which 305 were primary patients. Recurrences occurred in 413 patients (57 %). History of recurrences,history of intravesical treatment, grade 2, multiple tumors, and adjuvant treatment with epirubicin were relevant predictors for recurrence-free survival with hazard ratios of 1.48, 1.38, 1.22, 1.56, and 1.27, respectively. A table for recurrence probabilities was developed using these five predictors. Based on the probability of recurrence, three risk groups were identified. Patients in each of the separate risk groups should be scheduled for less or more aggressive treatment. The model showed sufficient discrimination and good predictive accuracy. External validation showed good validity. |
3 |
| 9. Eifler JB, Barocas DA, Resnick MJ. Predictors of outcome in bladder cancer. J. Natl. Compr. Cancer Netw.. 12(11):1549-54, 2014 Nov. |
Review/Other-Dx |
N/A |
To address how current nomograms and risk tables may be best used to individualize bladder cancer management. |
No results stated in the abstract |
4 |
| 10. Muppa P, Gupta S, Frank I, et al. Prognostic significance of lymphatic, vascular and perineural invasion for bladder cancer patients treated by radical cystectomy. Pathology. 49(3):259-266, 2017 Apr. |
Observational-Dx |
1504 patients |
To examine a large cohort of surgically treated bladder cancer patients to determine the significance of lymphatic, vascular, and perineural invasion in predicting bladder cancer specific survival. |
Multivariate analysis showed that lymphatic and vascular invasion but not perineural invasion were significantly associated with cancer specific survival (p < 0.0001 and p = 0.02, respectively). There was a significant association of lymphatic and vascular invasion but not perineural invasion with involved regional lymph nodes (p < 0.0001 and p = 0.004, respectively). In patients with metastasis to regional lymph nodes, lymphatic invasion remained significantly associated with outcome (p = 0.02). The frequency of lymphatic and vascular invasion varied amongst histological subtypes of bladder cancer. |
2 |
| 11. Tobisu K, Tanaka Y, Mizutani T, Kakizoe T. Transitional cell carcinoma of the urethra in men following cystectomy for bladder cancer: multivariate analysis for risk factors. J Urol. 1991; 146(6):1551-1553; discussion 1553-1554. |
Review/Other-Tx |
169 patients |
To examine, by multivariate analysis, the risk factors for occurrence of urethral TCC after cystectomy for bladder TCC. |
Significant risk factors were: papillary cancer, multiple cancers, and tumors in the bladder neck, prostatic urethra or prostate. |
4 |
| 12. Kim SP, Frank I, Cheville JC, et al. The impact of squamous and glandular differentiation on survival after radical cystectomy for urothelial carcinoma. J Urol. 188(2):405-9, 2012 Aug. |
Observational-Tx |
1013 patients |
To investigate the clinicopathological outcomes of patients treated with cystectomy for pure urothelial carcinoma vs urothelial carcinoma, and squamous and/or glandular differentiation. |
Patients with urothelial carcinoma, and squamous and/or glandular differentiation were more likely to have pT3-T4 tumors (70% vs 38%, p <0.0001)and pN+ disease (20% vs 15%, p = 0.05) than those with pure urothelial carcinoma. Median followup was 11.4 years. A total of 432 patients died ofbladder cancer, including 77 with histological differentiation and 355 with pure urothelial carcinoma. Ten-year cancer specific survival did not significantly differbetween patients with urothelial carcinoma and histological differentiation, and those with pure urothelial carcinoma (52% vs 51%, p = 0.71). After adjusting forclinicopathological features squamous and/or glandular differentiation was not significantly associated with the risk of death from bladder cancer (HR 0.79, p =0.10). |
2 |
| 13. Linder BJ, Frank I, Cheville JC, et al. Outcomes following radical cystectomy for nested variant of urothelial carcinoma: a matched cohort analysis. J Urol. 189(5):1670-5, 2013 May. |
Observational-Tx |
52 patients |
To evaluate oncological outcomes after radical cystectomy in patients with the nested variant of urothelial carcinoma and compare survival to that inpatients with pure urothelial carcinoma of the bladder. |
Patients with the nested variant had a median age of 69.5 years (IQR 62, 74) and a median postoperative followup of 10.8 years (IQR 9.3, 11.2). Nestedvariant cancer was associated with a high rate of adverse pathological features since 36 patients (69%) had pT3–T4 disease and 10 (19%) had nodal invasion.Eight patients (15%) with nested variant cancer received perioperative chemotherapy. When patients with the nested variant were matched to a cohort withpure urothelial carcinoma, no significant differences were noted in 10-year local recurrence-free survival (83% vs 80%, p = 0.46) or 10-year cancer specific survival (41% vs 46%, p = 0.75). |
2 |
| 14. Wang JK, Boorjian SA, Cheville JC, et al. Outcomes following radical cystectomy for micropapillary bladder cancer versus pure urothelial carcinoma: a matched cohort analysis. World J Urol. 30(6):801-6, 2012 Dec. |
Review/Other-Dx |
821 patients |
To report the outcomes of patients with MP bladder cancer treated with radical cystectomy (RC) and compare survival to patients with pure UC of the bladder. |
MP cancers were associated with a high rate of adverse pathologic features, as 48/73 patients (66 %) had pT3/4 tumors and 37 (50 %) had pN+ disease. Ten-year cancer-specific survival in MP patients was 31 %, compared with 53 % in the overall cohort with pure UC (p = 0.001). When patients with MP bladder cancer were then stage-matched to those with pure UC, no significant differences between the groups were noted with regard to 10-year local recurrence-free survival (62 vs. 69 %; p = 0.87), distant metastasis-free survival (44 vs. 56 %; p = 0.54), or cancer-specific survival (31 vs. 40 %; p = 0.41). |
4 |
| 15. Herr HW, Milan TN, Dalbagni G. BCG-refractory vs. BCG-relapsing non-muscle-invasive bladder cancer: a prospective cohort outcomes study. UROL. ONCOL.. 33(3):108.e1-4, 2015 Mar. |
Observational-Tx |
32 patients |
To test the hypothesis that BCG (bacille Calmette-Guérin)-refractory patients who fail to respond to BCG have worse outcomes after bladder-sparing treatments compared with BCG-relapsing patients whose tumors recur after at least a 6-month disease-free interval. |
Seventeen patients were classified as BCG refractory and 15 patients defined BCG relapsing. Recurrence-free median survivaltime was 10 months for BCG-refractory patients receiving mycobacterial cell wall–DNA complex vs. 23 months for BCG-relapsing patientswho received another induction course of BCG therapy (P = 0.002). Progression-free survival time was 18 months for BCG-refractory vs.52 months for BCG-relapsing patients (P = 0.001). Of the 17 BCG-refractory patients, 8 (47%) have died vs. 3 (20%) of the 15 BCGrelapsingpatients. |
1 |
| 16. Shirakawa H, Kikuchi E, Tanaka N, et al. Prognostic significance of Bacillus Calmette-Guerin failure classification in non-muscle-invasive bladder cancer. BJU Int. 110(6 Pt B):E216-21, 2012 Sep. |
Review/Other-Tx |
173 patients |
To investigate the differences in the clinical features and subsequent stage progression and disease-specific survival among patients with Bacillus Calmette-Guérin (BCG) failure, after dividing these patients into BCG-refractory, -resistant, -relapsing, and -intolerant groups. |
• Median follow-up period from initial BCG failure was 4.7 years. • A total of 42 patients (24.3%) were stratified into the BCG-refractory, three (1.7%) into the BCG-resistant, 106 (61.3%) into the BCG-relapsing, and 22 (12.7%)into the BCG-intolerant group.• Twenty-four patients (13.9%) experienced stage progression during follow-up.• Multivariate analysis showed that pathological G3 at BCG failure ( P = 0.014; risk ratio 2.84) and BCG-refractory ( P < 0.001; risk ratio 4.68) were independentpredictors for stage progression. The 10-year progression-free survival rates were 53.2%, 91.1% and 93.8% in the BCG-refractory, BCG-relapsing and BCG-intolerant groups, respectively. The stage progression rate was higher in the BCG-refractory than in the BCG-relapsing ( P < 0.001) and BCG-intolerant ( P = 0.007)groups.• Similarly, the 10-year disease-specific survival rate in the BCG-refractory group was significantly worse than those in the other BCG failure groups ( P < 0.001). |
4 |
| 17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 240(2):205-13, 2004 Aug. |
Review/Other-Dx |
6336 patients |
first, to propose an improved classification of surgical complications based on our experience gained with the previous classification1 ; second, to test this classification in a large cohort of patients who underwent general surgery; and third, to assess the reproducibility and acceptability of the classification through an international survey. |
The new ranking system significantly correlated with complexity of surgery (P < 0.0001) as well as with the length of the hospital stay (P < 0.0001). A total of 144 surgeons from 10 different centers around the world and at different levels of training returned the survey. Ninety percent of the case presentations were correctly graded. The classification was considered to be simple (92% of the respondents), reproducible (91%), logical (92%), useful (90%), and comprehensive (89%). The answers of both questionnaires were not dependent on the origin of the reply and the level of training of the surgeons. |
4 |
| 18. Kobayashi H, Kikuchi E, Mikami S, et al. Long term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors: tumor recurrence and worsening progression. BMC Urol. 14:5, 2014 Jan 08. |
Review/Other-Dx |
190 patients |
To evaluate the clinical outcome of low grade Ta bladder cancer followed-up for a long period using the 2004 WHO grading system. |
Tumor recurrence and WP occurred in 82 (43.2%) and 21 (11.1%) patients during follow-up (median follow-up: 101.5 months), respectively. WP to high grade Ta, all T1 or Tis/concomitant CIS was seen in 17 patients, and UTR and progression to equal to or more than T2 were seen in 2 and 2 patients, respectively. Multivariate analyses demonstrated that multiple tumor (p < 0.001, HR: 2.97) and absence of intravesical instillation (IVI) (p < 0.001, HR: 2.88) were significant risk factors for tumor recurrence while multiple tumor was the only risk factor for WP (p = 0.001, HR: 5.26). After a 5-year tumor-free period, 9 patients experienced late recurrence in years 5 and 10 and were diagnosed at a follow-up cystoscopy, however, only 2 patients recurred beyond 10 years and werefound by gross hematuria. There were no significant risk factors of late recurrence. |
4 |
| 19. Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J, Huguet-Perez J, Vicente-Rodriguez J. Upper urinary tract tumors after primary superficial bladder tumors: prognostic factors and risk groups. J Urol. 164(4):1183-7, 2000 Oct. |
Observational-Dx |
1529 patients |
1. To evaluate the prognostic factors of primary superficial bladder cancer that may predict a metachronous upper urinary tract tumor.2. To determine whether the incidence of upper urinary tract disease varies according to risk group based on primary superficial bladdertumor classification. |
The incidence of upper urinary tract cancer was 2.6%. The only factor prognostic for an upper urinary tract tumor was multiplicity (relative risk 2.7, 95% confidence interval [CI] 1.06 to 6.84). All patients with an upper urinary tract tumor had a previously recurrent primary superficial bladder tumor. In the low, intermediate and high risk groups the incidence of upper urinary tract cancer was 0.6% (relative risk 1), 1.8% (relative risk 3.1, 95% CI 0.4 to 23.9) and4.1% (relative risk 8.3, 95% CI 1.1 to 61.6), respectively (chi-square and log rank tests p 5 0.007 and p ,0.05, respectively). |
3 |
| 20. Hurle R, Losa A, Manzetti A, Lembo A. Upper urinary tract tumors developing after treatment of superficial bladder cancer: 7-year follow-up of 591 consecutive patients. Urology. 53(6):1144-8, 1999 Jun. |
Review/Other-Dx |
591 patients |
To evaluate upper urinary tract tumor (UUTT) incidence and characteristics in 591 consecutive patients with low-, intermediate-, or high-risk superficial bladder cancer, who were followed up for at least 5 years or until death. |
After a median follow-up of 86 months (range 20 to 143), 2 (0.9%) of 216 patients at low risk, 4 (2.2%) of 182 patients at intermediate risk, and 19 (9.8%) of 193 patients at high risk developed UUTTs. The incidence of UUTTs is significantly higher in patients at high risk than in those at low risk (P 5 0.0004, oddsratio 5 11.6, 95% confidence interval [CI] 2.5 to 40.7) or at intermediate risk (P 5 0.004, odds ratio 5 4.8, 95% CI 1.5 to 17.2), or both (P 5 0.000006, odds ratio 5 7.3, 95% CI 2.6 to 20.3). The difference between patients at low risk and those at intermediate risk was not statistically significant (P 5 0.5, odds ratio 5 0.4,95% CI 0.02 to 2.6). After a median time of 36 months (range 9 to 119) from UUTT diagnosis, 5 (20%) of 25 patients have died of the disease. |
4 |
| 21. Ok BG, Ji YS, Ko YH, Song PH. Usefulness of urine cytology as a routine work-up in the detection of recurrence in patients with prior non-muscle-invasive bladder cancer: practicality and cost-effectiveness. Korean J Urol. 55(10):650-5, 2014 Oct. |
Observational-Dx |
393 patients |
To investigate the usefulness of urine cytology in the detection of tumor recurrence in terms of practicality and cost-effectiveness. |
Forty-nine patients were confirmed to have tumor recurrence and 13 patients were confirmed to have inflammation by pathology. The overall tumor recurrence ratewas 12.5% (49/393) and recurrent cases were revealed as NMIBC. Sensitivity in group I (24.5%) was lower than in group II (55.1%, p=0.001) and group III (57.1%, p<0.001). However, in group VII (77.6%), the sensitivity was statistically similar to that of group VI (75.5%, p=0.872). Under the Korean insurance system, total cost per cancer detected for group VII was almost double that of group VI (p=0.041). |
3 |
| 22. Yafi FA, Brimo F, Auger M, Aprikian A, Tanguay S, Kassouf W. Is the performance of urinary cytology as high as reported historically? A contemporary analysis in the detection and surveillance of bladder cancer. UROL. ONCOL.. 32(1):27.e1-6, 2014 Jan. |
Observational-Dx |
1,114 patients |
To evaluate sensitivity and specificity of urine cytology during a contemporary period at McGill University Health Center, Montreal, Quebec, Canada in comparison with historical analysis and other reported urinary biomarkers. |
On cytologic examination, 71% of specimens were benign, 23% atypical, and 6% suspicious or positive for urothelialcarcinoma. Reason for collection was surveillance in 61% and new symptoms in 28%. Depending on the tumor grade, sensitivity resultsranged from 10% for low-grade to 51% for high-grade tumors. Importantly, specificity of urine cytology ranged from 83% to 88%(depending on the type of urine collection and type of clinical presentation). Anticipatory positive rate was 44% after a median time of 15months. Specificity of other reported urinary markers ranges from 40% to 90%. |
3 |
| 23. Sternberg IA, Keren Paz GE, Chen LY, et al. Upper tract imaging surveillance is not effective in diagnosing upper tract recurrence in patients followed for nonmuscle invasive bladder cancer. J Urol. 190(4):1187-91, 2013 Oct. |
Observational-Dx |
935 patients |
To evaluate the usefulness of routine upper tract imaging in patients followed for nonmuscle invasive bladder cancer. |
Of 935 patients treated and followed for nonmuscle invasive bladder cancer 51 were diagnosed with upper tract urothelial carcinoma. Median followupwas 5.5 years. The 5-year upper tract urothelial carcinoma-free probability among patients with Ta and T1 disease was 98% and 93%, respectively.The 10-year upper tract urothelial carcinoma-free probability among patients with Ta and T1 disease was 94% and 88%, respectively. Only 15 (29%) patientswere diagnosed on routine imaging while the others were diagnosed after symptoms developed. Overall 3,074 routine imaging scans were conducted for anoverall efficacy of 0.49% |
3 |
| 24. Woo S, Suh CH, Kim SY, Cho JY, Kim SH. Diagnostic performance of MRI for prediction of muscle-invasiveness of bladder cancer: A systematic review and meta-analysis. [Review]. Eur J Radiol. 95:46-55, 2017 Oct. |
Meta-analysis |
24 studies (1774 patients) |
To review the diagnostic performance of =1.5-T MRI for local staging of bladder cancer. |
Pooled sensitivity was 0.92 (95% CI 0.88–0.95) with specificity of 0.87 (95% CI 0.78–0.93). Sensitivity analyses showed that sensitivity estimates were comparable and consistently high across all subgroups, but specificity estimates were variable. Studies using 3-T scanners had higher specificity (0.93 [95% CI 0.86–0.98]) than those using 1.5-T scanners (0.83 [95% CI 0.74–0.98]). Studies using multiparametric MRI (conventional + =2 functional sequences) showed the highest accuracy with sensitivity and specificity of 0.94 (95% CI 0.89–1.00) and 0.95 (95% CI 0.89–0.98), respectively. |
Good |
| 25. Gandhi N, Krishna S, Booth CM, et al. Diagnostic accuracy of magnetic resonance imaging for tumour staging of bladder cancer: systematic review and meta-analysis. BJU Int. 122(5):744-753, 2018 11. |
Meta-analysis |
4 studies with 259 patients |
To evaluate accuracy of magnetic resonance imaging (MRI) for local staging of bladder cancer for four clinical scenarios (T-stage thresholds) considered against current standards for clinical staging and secondarily to identify sources for variability in accuracy. |
The pooled results showed 0.84 of sensitivity [95% confidence interval (CI) = 0.79-0.89], 0.91 of specificity (95% CI = 0.87–0.93), 8.24 of +LR (95% CI = 4.87–13.92), 0.18 of –LR (95% CI = 0.10–0.31), 49.42 of DOR (95% CI = 19.07–128.09), and 0.946 of AUC. The Spearman correlation analysis found no threshold effect (p = 0.684). A significant heterogeneity existed among 4 included studies with sensitivity (I2 = 65.7%), specificity (I2 = 60.0%) and diagnostic OR (I2 = 67.5%). The Begg's test (p = 0.497) and the egger's test (p = 0.337) found no publication bias. |
Inadequate |
| 26. Huang L, Kong Q, Liu Z, Wang J, Kang Z, Zhu Y. The Diagnostic Value of MR Imaging in Differentiating T Staging of Bladder Cancer: A Meta-Analysis. [Review]. Radiology. 286(2):502-511, 2018 02. |
Meta-analysis |
Seventeen studies (1449 patients with bladder cancer) |
To assess the diagnostic accuracy of magnetic resonance (MR) imaging for differentiating stage T1 or lower tumors from stage T2 or higher tumors and to analyze the influence of different imaging protocols in patients with bladder cancer. |
he pooled sensitivity and specificity of MR imaging were 0.90 (95% confidence interval [CI]: 0.83, 0.94) and 0.88 (95% CI: 0.77, 0.94), respectively, for differentiating tumors staged T1 or lower from those staged T2 or higher. Diffusion-weighted imaging and use of higher field strengths (3 T) improved sensitivity (0.92; 95% CI: 0.86, 0.96) and specificity (0.96; 95% CI: 0.93, 0.98). |
Good |
| 27. Ueno Y, Takeuchi M, Tamada T, et al. Diagnostic Accuracy and Interobserver Agreement for the Vesical Imaging-Reporting and Data System for Muscle-invasive Bladder Cancer: A Multireader Validation Study. Eur Urol. 76(1):54-56, 2019 Jul. |
Observational-Dx |
74 patients |
To evaluate the interobserver agreement and diagnostic performance of VI-RADS. |
The area under the ROC curve (AUC) was estimated for ordinal score assessments. Our study demonstrated that interobserver agreement was excellent among five readers (ICC 0.85, 95% confidence interval 0.80-0.89) and the diagnostic performance of VI-RADS was represented as a pooled AUC of 0.90 (95% confidence interval 0.87-0.93). |
2 |
| 28. Wang H, Luo C, Zhang F, et al. Multiparametric MRI for Bladder Cancer: Validation of VI-RADS for the Detection of Detrusor Muscle Invasion. Radiology. 291(3):668-674, 2019 06. |
Observational-Dx |
340 patients |
To determine the performance of the VI-RADS score in detecting muscle-invasive bladder cancer in a cohort of patients undergoing multiparametric MRI before surgery. |
Of 340 tumors, 255 (75.0%) were verified as non–muscle-invasive and 85 (25.0%) as muscle-invasive bladder cancer. Both the VI-RADS score and its components were associated with muscle-invasive condition (P < .001). The area under the receiver operating characteristic curve for VI-RADS for muscle invasion was 0.94 (95% confidence interval [CI]: 0.90, 0.98). The sensitivity and specificity of a VI-RADS score of 3 or greater were 87.1% (95% CI: 78%, 93%) and 96.5% (95% CI: 93%, 98%), respectively. |
2 |
| 29. Rosenkrantz AB, Ego-Osuala IO, Khalef V, Deng FM, Taneja SS, Huang WC. Investigation of Multisequence Magnetic Resonance Imaging for Detection of Recurrent Tumor After Transurethral Resection for Bladder Cancer. J Comput Assist Tomogr. 40(2):201-5, 2016 Mar-Apr. |
Observational-Dx |
36 patients |
To evaluate multisequence magnetic resonance imaging (MRI) in detecting local recurrence after transurethral resection for bladder cancer. |
Forty-seven percent of patients had recurrent tumor at cystoscopy and biopsy. Using multisequence MRI, sensitivity and specificity were 67% and 81% for R1 and 73% and 62% for R2. Both readers missed 1 high-grade pathologic stage T1 recurrent tumor; otherwise, all missed tumors were low-grade pathologic stage Ta lesions. All false positives for R1 and 7 of 9 false positives for R2were in patients receiving previous bacillus Calmette-Guerin therapy. Furthermore, 40% to 50% of solitary abnormalities and 83%to 100%ofmultifocal abnormalitieswere tumor recurrences; 12% to 20% of smooth wall thickening, 50% to 75% of irregular wallthickening, and 88% to 100% of papillary masses were tumor recurrences. |
2 |
| 30. Wang HJ, Pui MH, Guo Y, Yang D, Pan BT, Zhou XH. Diffusion-weighted MRI in bladder carcinoma: the differentiation between tumor recurrence and benign changes after resection. Abdom Imaging. 39(1):135-41, 2014 Feb. |
Observational-Dx |
11 patients |
To investigate the efficacy of diffusion-weighted MRI (DWI) in differentiating recurrent tumor from chronic inflammation and fibrosis after cystectomy ortransurethral resection of bladder cancer. |
The accuracies, sensitivities, specificities, and positive predict values of DWI (92.6%, 100%, 81.8%, and 88.9%) were higher than those of DCEMRI (59.3%, 81.3%, 27.3%, and 54.2%) for detecting recurrent tumors. Using receiver operating characteristic analysis, the accuracy of DWI was significantly higher than that of DCE MRI (P < 0.05). There was no significant difference between DWI diagnosis and histopathology (P > 0.05), whereas the difference between diagnosis of DCEMRI and histopathology was significant (P < 0.05). The normalized apparent diffusion coefficients of recurrent tumors (0.697 ± 0.219) were significantly (P < 0.05) lower than those of postoperative inflammation or fibrosis (1.019 ± 0.143). |
2 |
| 31. Lee KS, Zeikus E, DeWolf WC, Rofsky NM, Pedrosa I. MR urography versus retrograde pyelography/ureteroscopy for the exclusion of upper urinary tract malignancy. Clin Radiol. 2010; 65(3):185-192. |
Observational-Dx |
35 patients |
To evaluate the diagnostic performance of MRU vs retrograde pyelography and/or ureteroscopy in the detection of upper urinary tract neoplasms. |
A total of 113 regions were analyzed on MRU and 90 regions on retrograde pyelography and/or ureteroscopy. 19 neoplasms were identified. Sensitivity, specificity, PPV, and NPV for the detection of urinary tract neoplasms were 63%, 91%, 60%, and 92% for MRU, respectively, and 53%, 97%, 83%, and 88% for retrograde pyelography and/or ureteroscopy, respectively. These differences were not statistically significant (P>0.05). |
3 |
| 32. Stamatiou K, Moschouris H, Papadaki M, Perlepes G, Skolarikos A. Accuracy of modern ultrasonographic techniques in the follow up of patients with superficial bladder carcinoma. Med Ultrason. 2011; 13(2):114-119. |
Experimental-Dx |
33 patients |
To establish the accuracy of modern US techniques in the follow-up of patients with superficial bladder carcinoma and to evaluate the patients tolerability of cystoscopy. |
14/33 subjects were found to have bladder carcinoma recurrence on cystoscopy. In 11 cases (78.57%) US accurately diagnosed the bladder carcinoma. 2/3 patients in which, the US examination failed to clearly diagnose bladder carcinoma, were found with a tumor <3 mm while, in the remaining patient the tumor was located in the inner part of a diverticula. The sensitivity of modern US techniques in the diagnosis of bladder cancer recurrence was 78.5%, the specificity 100%, the PPV 100% and the NPV 86.3%. Regarding the patient tolerability for cystoscopy, 17 patients (51.5%) reported excessive discomfort-low tolerability, 9 (27.2%) moderate discomfort-intermediate tolerability and 7 (21.2%) reported no discomfort-high tolerability. |
2 |
| 33. Kocakoc E, Kiris A, Orhan I, Poyraz AK, Artas H, Firdolas F. Detection of bladder tumors with 3-dimensional sonography and virtual sonographic cystoscopy. J Ultrasound Med. 2008; 27(1):45-53. |
Observational-Dx |
31 patients |
To assess the use of 3-D US and virtual sonographic cystoscopy for the detection of bladder tumors. |
28 (90.3%) of 31 3-D virtual sonographic cystoscopic studies had good or excellent image quality. Conventional cystoscopy revealed 47 lesions in 22/28 patients; 3-D sonographic virtual cystoscopy showed 41 (87.2%) of 47 lesions. 3-D virtual sonography alone had sensitivity of 96.2%, specificity of 70.6%, a PPV of 93.9%, and a NPV of 80% for tumor detection. The combination of gray scale sonography, multiplanar reconstruction, and 3D virtual sonography had sensitivity of 96.4%, specificity of 88.8%, a PPV of 97.6%, and a NPV of 84.2% for tumor detection. |
2 |
| 34. Chamie K, Ballon-Landa E, Daskivich TJ, et al. Treatment and survival in patients with recurrent high-risk non-muscle-invasive bladder cancer. UROL. ONCOL.. 33(1):20.e9-17, 2015 Jan. |
Observational-Dx |
4521 subjects |
To determine whether the increasing number of recurrences in patients with high-risk non–muscle-invasive bladder cancer is associated with higher subsequenttreatment and mortality rates. |
Of 4,521 subjects, 2,694 (59.6%) had multiple recurrences within 2 years of diagnosis. Compared with patients who only had 1recurrence, those with Z4 recurrences were less likely to undergo radical cystectomy (hazard ratio [HR] ¼ 0.73, 95% CI: 0.58–0.92), yetmore likely to undergo radiotherapy (HR ¼ 1.51, 95% CI: 1.23–1.85) and systemic chemotherapy (HR ¼ 1.58, 95% CI: 1.15–2.18). Forpatients with Z4 recurrences, only 25% were treated with curative intent. The 10-year cancer-specific mortality rates were 6.9%, 9.7%,13.7%, and 15.7% for those with 1, 2, 3, and Z4 recurrences, respectively. |
3 |
| 35. Canter DJ, Revenig LM, Smith ZL, et al. Re-examination of the natural history of high-grade T1 bladder cancer using a large contemporary cohort. Int Braz J Urol. 40(2):172-8, 2014 Mar-Apr. |
Review/Other-Dx |
222 patients |
To re-examine the natural history of HGT1 bladder cancer by analyzing the recurrence and progression rates of a large cohort of patients initially diagnosed with HGT1 disease to determine if, in fact, the high incidence of disease progression and death due to bladder cancer is still witnessed in a more contemporarytreatment era. |
A total of 222 patients were identified; 198 (89.1%) and 199 (89.6%) of whom were male and non-African American, respectively. Mean patient age was 66.5 years. 191 (86.0%) of the patients presented with isolated HG T1 disease while 31 (14.0%) patients presented with HGT1 disease and CIS. Induction BCG was utilized in 175 (78.8%) patients. Recurrence occurred in 112 (50.5%) patients with progression occurring in only 19 (8.6%) patients. At a mean follow-up of 51 months, overall survival was 76.6%. Fifty two patients died, of whom only 13 (25%) patient deaths were bladder cancer related. |
4 |
| 36. Liedberg F, Hagberg O, Holmang S, et al. Local recurrence and progression of non-muscle-invasive bladder cancer in Sweden: a population-based follow-up study. Scand J Urol. 49(4):290-5, 2015. |
Review/Other-Dx |
4715 patients |
To investigate recurrence and progression of non-muscle-invasive bladder cancer (NMIBC) in a large population-based setting. |
Local bladder recurrence and progression occurred in 50 and 9% of the patients, respectively. The rate of local recurrence was 56% in thesouthern healthcare region compared to 37% in the northern region. A multivariate Cox proportional hazards model, adjusting for age, gender, tumour stage and grade, intravesical treatment, healthcare region and hospital volume, showed that recurrence was associated with TaG2 and T1 disease, no intravesical treatment and treatment in the southern healthcare region, but indicated a lower risk of recurrence in the northern healthcare region. Adjusting for the samefactors in a multivariate analysis suggested that increased relative risk of progression correlated with older age, higher tumour stage and grade, and diagnosis in the Uppsala/Örebro healthcare region, whereas such risk was decreased by intravesical treatment (relative risk 0.72, 95% confidence interval 0.55–0.93, p = 0.012). |
4 |
| 37. Miyake M, Gotoh D, Shimada K, et al. Exploration of risk factors predicting outcomes for primary T1 high-grade bladder cancer and validation of the Spanish Urological Club for Oncological Treatment scoring model: Long-term follow-up experience at a single institute. Int J Urol. 22(6):541-7, 2015 Jun. |
Observational-Dx |
106 patients |
To determine the prognostic factors of primary T1 high-grade bladder cancer and to validate the Spanish Urological Club for Oncological Treatment model in Japanese patients with T1 high-grade bladder cancer treated at a single institution. |
Of 106 patients, 44 (42%) had recurrence and 16 (15%) developed progression after a median (interquartile range) follow-up period of 54 months (range 32–81 months). Non-papillary shape was the only independent predictor for recurrence, while broadbased tumor stalk and infiltrative tumor growth pattern at the invasion front were determined to be independent predictors for progression. Stratification of patients according to the number of progression risk factors yielded hazard ratios of 10.1 and 13.1 in patients having one and two risks, respectively, compared with those without any risks. The Spanish Urological Club for Oncological Treatment model successfully stratified our patients with a trend toward different probabilities of recurrence and progression. |
3 |
| 38. Kim JY, Kim SH, Lee HJ, Kim MJ, Kim YH, Cho SH. MDCT urography for detecting recurrence after transurethral resection of bladder cancer: comparison of nephrographic phase with pyelographic phase. AJR Am J Roentgenol. 203(5):1021-7, 2014 Nov. |
Observational-Dx |
121 patients |
To prospectively compare nephrographic phase MDCT urography performed with oral hydration and a diuretic with standard pyelographic phase MDCT in the detection of recurrence after transurethral resection. |
Urinary tract distention was rated significantly better at the pyelographic phase for all segments (p < 0.001). The degree of opacification provided by each radiologist for the same segment showed high correlation. There were 59 bladder recurrences in 38 patients and 19 upper tract recurrences in 13 patients. For recurrence detection in the bladder, the overall accuracy was significantly higher for the nephrographic phase than the pyelographic phase (91.7% [354/386] vs 83.2% [321/386], p = 0.038). For recurrence detection in the upper tract, the overall accuracy was significantly higher in the nephrographic phase thanin the pyelographic phase (86.7% [260/300] vs 80% [240/300], p = 0.028). |
1 |
| 39. Sadow CA, Silverman SG, O'Leary MP, Signorovitch JE. Bladder cancer detection with CT urography in an Academic Medical Center. Radiology. 2008;249(1):195-202. |
Observational-Dx |
838 CT urograms in 779 patients |
To evaluate the performance characteristics of CTU for the detection of bladder cancer in patients at risk for the disease. |
The overall sensitivity, specificity, accuracy, PPV, and NPV for bladder cancer detection were 79% (117/149), 94% (649/689), 91% (766/838), 75% (117/157), and 95% (649/681) for CTU and 95% (142/149), 92% (634/689), 93% (776/838), 72% (142/197), and 99% (634/641) for cystoscopy. The NPV of CTU was higher in patients evaluated for hematuria alone (98%, 589/603). However, the accuracy of CTU was considerably lower in patients with a prior urothelial malignancy (78%, 123/158). |
3 |
| 40. Takahashi N, Glockner JF, Hartman RP, et al. Gadolinium enhanced magnetic resonance urography for upper urinary tract malignancy. J Urol. 183(4):1330-65, 2010 Apr. |
Observational-Dx |
91 MRU studies in 70 males and 18 females |
To retrospectively evaluate the accuracy of gadolinium enhanced MRU to detect upper urinary tract tumors. |
A total of 35 urinary tract regions in 18 males and 7 females with a mean age of 70.4 years were confirmed to have an upper tract malignant tumor and 219 urinary tract regions were confirmed to be tumor-free. Sensitivity, specificity and accuracy to detect upper urinary tract malignancy were 74.3%, 96.8% and 93.7% for reviewer 1, and 62.9%, 96.3% and 91.7% for reviewer 2, respectively. When patients with a ureteral stent or nephrostomy tube were excluded from analysis, sensitivity, specificity and accuracy were 86.2%, 99.5% and 97.7% for reviewer 1, and 72.4%, 97.9% and 94.6% for reviewer 2, respectively. |
2 |
| 41. Hong X, Li T, Ling F, et al. Impact of surgical margin status on the outcome of bladder cancer treated by radical cystectomy: a meta-analysis. Oncotarget. 8(10):17258-17269, 2017 Mar 07. |
Meta-analysis |
36 articles, and 38,384 patients |
To assess the associations between the outcomes of bladder cancer, in terms of recurrence-free survival (RFS), cancerspecific survival (CSS) and overall survival (OS), and the presence of positive surgical margins versus negative surgical margins following treatment with radical cystectomy (RC) |
4,354 patients were reported to have positive surgical margins. Significant associations were detected between positive surgical margins following RC and unfavorable RFS [summary relative risk estimate (SRRE), 1.63; 95% confidence interval (CI), 1.46-1.83; P = 0.105], CSS (SRRE, 1.82;95% CI, 1.63-2.04; P = 0.001) and OS (SRRE, 1.68; 95% CI, 1.58-1.80; P = 0.805), by fixed or random effects models. The findings were consistent independently of age, sample size, publication year, follow-up duration, study type and geographical region. |
Good |
| 42. Mallen E, Gil P, Gil MJ. Risk groups in bladder cancer patients treated with radical cystectomy. Int Braz J Urol. 41(1):30-9, 2015 Jan-Feb. |
Observational-Dx |
563 patients |
To stratify patients with bladder cancer into homogeneous risk groups according to statistically significant differences found in PFS (progression-free survival).To identify those patients at increased risk of progression and to provide oncological follow-up according to patient risk group. |
Median follow up time was 37.8 months. Recurrence occurred in a total of 219 patients (38, 9%). In 63% of cases this was distant recurrence.Only two variables retained independent prognostic value in the multivariate analysis for PFS: pathological organ confinement and lymph node involvement. By combining these two variables, we created a new “risk group” variable. In this second model it was found that the new variable behaved as an independent predictor associated with PFS. Four risk groups were identified: very low, low, intermediate and high risk:Very low risk: pT0 N0Low risk: pTa, pTis, pT2 and pN0Intermediate risk: pT3 and pN0High risk: pT4 N0 or pN1-3. |
3 |
| 43. Nieuwenhuijzen JA, de Vries RR, van Tinteren H, et al. Follow-up after cystectomy: regularly scheduled, risk adjusted, or symptom guided? Patterns of recurrence, relapse presentation, and survival after cystectomy. Eur J Surg Oncol. 40(12):1677-85, 2014 Dec. |
Observational-Dx |
343 patients |
To evaluate the efficacy of follow-up based on the patterns of recurrence, relapse presentation and survival after cystectomy, and to define a risk adjusted follow-up schedule. |
The risk of a recurrence was related to increasing pT, tumour positive lymph nodes, tumour positive surgical margins, and preoperative dilatation of the upper urinary tract, and low and high risk groups were defined consequently. 84% of all recurrences occurred within 2 years, with only one recurrence beyond 2 years in the low risk group. Although the minority of all patients (34%) is asymptomatic at time of recurrence, symptomatic recurrences were adversely associated with survival. CT-scans and chest X-rays accounted for 90% of the diagnostic tools to detect a recurrence in patients without symptoms. |
3 |
| 44. Salama A, Abdelmaksoud AM, Shawki A, Abdelbary A, Aboulkassem H. Outcome of Muscle-Invasive Urothelial Bladder Cancer After Radical Cystectomy. Clin Genitourin Cancer. 14(1):e43-7, 2016 Feb. |
Review/Other-Tx |
189 patients |
To clarify reasons for recurrence of urothelial carcinoma after radical cystectomy in a retrospective study that included 189 patients. |
The 3-year disease-free survival (DFS) rate was 56%. Seventy patients (37%) developed disease recurrence during the follow-up period. Of these recurrences, 17 patients (24.3%) developed local and/ or regional recurrences, 45 patients (64.3%) developed distant metastasis, and 8 patients (11.4%) developed localand/or regional and distant recurrences. In univariate analysis, lymph node metastasis (P < .001), lymphovascular invasion (LVI) (P < .001), high grade (P = .005), and advanced tumor stage (P = .002) were significantly associated with development of recurrence. In multivariate analysis, lymph node metastasis, LVI, and high grade were significantly associated with tumor recurrence and poor DFS. |
4 |
| 45. Reddy AV, Pariser JJ, Pearce SM, et al. Patterns of Failure After Radical Cystectomy for pT3-4 Bladder Cancer: Implications for Adjuvant Radiation Therapy. Int J Radiat Oncol Biol Phys. 94(5):1031-9, 2016 Apr 01. |
Observational-Dx |
334 patients |
To describe patterns of LF, as well as assess factors associated with local-regional failure (LF) in a cohort of patients with pT3-4 bladder cancer. |
A total of 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46% received perioperativechemotherapy. The median age was 71 years old, and median follow-up was 11 months. On univariate analysis, margin status, pT stage, and pN stage, were allassociated with LF (P<.05), however, on multivariate analysis, only pT and pN stages were significantly associated with LF (P<.05). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had a 2-year incidence of LF of 12%, 33%, and 72%, respectively. The most common sites of pelvic relapse included the external and internal iliac lymph nodes (LNs) and obturator LN regions. Notably, 34% of patients with LF had local-regional only disease at the time of recurrence. |
3 |
| 46. Moschini M, Karnes RJ, Sharma V, et al. Patterns and prognostic significance of clinical recurrences after radical cystectomy for bladder cancer: A 20-year single center experience. Eur J Surg Oncol. 42(5):735-43, 2016 May. |
Observational-Dx |
1110 patients |
To describe recurrence patterns and characteristics related to survival in patients treated with radical cystectomy (RC) due to bladder cancer (BCa) |
Data from 1110 patients with urothelial non-metastatic BCa at RC were analyzed with 7.5 years of median follow up. Overall, 324 patients experienced recurrence and 200 (61.7%) were single site recurrence. The locations were: 43 local (22 cystectomy bed and 21 pelvic lymph node dissection template), 138 distant (36 lung, 19 liver, 52 bone, 17 extra pelvic LN, 7 peritoneal, 4 brain and 3 others) and 19 secondary urothelial carcinoma (11 upper urinary tract, 8 urethra). Significant independent predictors of overall recurrence were pathological stage pT3/T4 vs. pT0-2, pathological N positive status and positive surgical margin. Median overall survival after recurrence was 18 months. At multivariate analysis, pathological T3 (Hazard ratio [HR]: 1.62), T4 (HR: 1.58), interval from RC to recurrence (HR: 0.92) and distant (HR: 2.57) recurrences were independently associated with CSM (all p < 0.05). |
3 |
| 47. Perlis N, Turker P, Bostrom PJ, et al. Upper urinary tract and urethral recurrences following radical cystectomy: review of risk factors and outcomes between centres with different follow-up protocols. World J Urol. 31(1):161-7, 2013 Feb. |
Experimental-Dx |
574 patients |
To examine which patient-related and tumourrelated characteristics predict upper urinary tract recurrence (UUTR) and urethral recurrence (UR) of bladder cancer post-radical cystectomy (RC). Secondary objective is to evaluate whether or not recurrence patterns are similar between two centres with different post-RC follow-up (F/U) protocols. |
There was a 3.7 % risk of UUTR (21/574) and a 3.6 % risk of UR (18/503) for the combined cohort at a median F/U of 45 months. When controlling for the effectsof all variables modelled, female gender was a significant risk factor for UUT recurrence (OR 3.2, 95 % CI 1.0–9.5, p = 0.03) and prostatic urethral involvement was a significant risk factor for urethral recurrence (OR 7.8, 95 % CI 2.2–27.6, p = 0.001). UUTR were similar (p = 0.82) between Turku (8/205) and Toronto (12/369). Urethral recurrences trended (p = 0.06) towards being more common in Turku (9/151, 6.0 %) versus Toronto (9/352, 2.6 %), but no difference in overall survival was demonstrated between sites. |
3 |
| 48. Mitra AP, Alemozaffar M, Harris BN, Schuckman AK, Skinner EC, Daneshmand S. Outcomes after urothelial recurrence in bladder cancer patients undergoing radical cystectomy. Urology. 84(6):1420-6, 2014 Dec. |
Observational-Dx |
2029 patients |
To identify factors prognostic for survival after urothelial recurrence after radical cystectomy for bladder cancer. |
At median follow-up of 12 years, 25 (31.3%) and 55 (68.7%) patients experienced recurrence in the upper tract and urethra, respectively. Median time to recurrence, PRDSS, and PROS were 25.9, 58.4, and 48.7 months, respectively. Older age (P ¼ .018), patients with tumors that were upstaged at cystectomy compared with their clinical stage (P ¼ .049), and positive surgical margins (P ¼ .022) were associated with a lower PROS. The presence of symptoms at follow-up was associated with a poor PRDSS (P ¼ .028), which was confirmed by multivariable analysis. Patients experiencing urothelial recurrence within 2 years of cystectomy had a lower PRDSS (P ¼ .002) and PROS (P ¼ .003), which was confirmed by multivariable analysis. Site of urothelial recurrence did not influence time to recurrence (P ¼ .87), PRDSS (P ¼ .72), or PROS (P ¼ .57). |
3 |
| 49. Balci U, Dogantekin E, Ozer K, Gorgel SN, Girgin C, Dincel C. Patterns, risks and outcomes of urethral recurrence after radical cystectomy for urothelial cancer; over 20 year single center experience. Int J Surg. 13:148-51, 2015 Jan. |
Review/Other-Dx |
287 male patients |
To evaluate the factors affecting urethral recurrence after radical cystectomy for bladder cancer and relationship between urinary diversion type and urethral recurrence rates. |
A Total of 287 patients. Orthotopic continent urinary diversion (OCD) and ileal conduit (IC) was performed after radical cystectomy in 141 (49.1%) and 146 (50.9%) patients respectively. Urethral recurrence was observed in 11 (3.8%) patients and urethral recurrence rates in OCD and IC groups were 1.4% and 6.2% (p ¼ 0.034). Pathological stages of recurrent patients were 2 pT1, 1 pT2 and 8 pT4 respectively (p < 0.001). Urethral recurrence was significantly lower in OCD group when compared to IC group (p ¼ 0.036). When all parameters were analyzed using Cox multivariate regression analysis, the most important factor that affects urethral recurrence was pathological T stage (p < 0.001). Risk factors for urethral recurrence were present in 92 patients. Urethral recurrence rates in patients with and without risk factors were 8.69% and 1.53% (p < 0.01). |
4 |
| 50. Kibel AS, Dehdashti F, Katz MD, et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography/computed tomography for staging of muscle-invasive bladder carcinoma. J Clin Oncol. 2009; 27(26):4314-4320. |
Observational-Dx |
43 chemotherapy-naive patients |
To report a prospective study of FDG-PET/CT in patients undergoing radical cystectomy for cT2-3N0M0 urothelial carcinoma of the bladder. |
Median follow-up was 14.9 months (range, 0.4 to 46.1 months). One patient who did not undergo lymphadenectomy was excluded from the pathology data analysis (n=42), whereas another patient who failed to return for follow-up was excluded from survival analysis (n=42). FDG-PET/CT demonstrated a PPV of 78% (7/9), a NPV of 91% (30/33), sensitivity of 70% (7/10), and specificity of 94% (30/ 32). Recurrence-free survival, disease-specific survival, and OS were all significantly poorer in the patients with positive FDG-PET/CT than in those with negative FDG-PET/CT. |
2 |
| 51. Lodde M, Lacombe L, Friede J, Morin F, Saourine A, Fradet Y. Evaluation of fluorodeoxyglucose positron-emission tomography with computed tomography for staging of urothelial carcinoma. BJU Int. 2010;106(5):658-663. |
Observational-Dx |
70 patients |
To investigate the role of FDG-PET combined with CT and forced diuresis, in the staging and follow-up of urothelial carcinoma. |
For the detection of primary urothelial bladder cancer, FDG-PET/CT was slightly more sensitive than CT (85% vs 77%) but less specific (25% vs 50%). For the detection of pelvic node metastasis FDG-PET/CT was more sensitive than CT (57% vs 33%) with a specificity of 100% for both imaging techniques. In 20 patients, extrapelvic FDG-PET/CT images showed suspected disease at the first evaluation. Urothelial carcinoma progressed in 9/10 patients who had synchronous multiple PET-positive retroperitoneal or mediastinal lymph nodes, and in only 2/9 with unique hyperactive lesions in the lung. FDG-PET/CT also detected a pT1G3 urothelial carcinoma of the renal pelvis and all bone metastases detected by bone scintigraphy. |
2 |
| 52. Vind-Kezunovic S, Bouchelouche K, Ipsen P, Hoyer S, Bell C, Bjerggaard Jensen J. Detection of Lymph Node Metastasis in Patients with Bladder Cancer using Maximum Standardised Uptake Value and 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: Results from a High-volume Centre Including Long-term Follow-up. Eur Urol Focus. 5(1):90-96, 2019 01. |
Observational-Dx |
119 patients |
To Assess the utility and clinical relevance of SUVmax in (18)F-FDG PET in detecting regional nodal metastases in patients considered for radical cystectomy. |
SUVmax >2 analysis: sensitivity±95% confidence interval of 79.4% (62.1-91.3) and specificity 66.5% (55.7-75.3). SUVmax >4 based analysis: sensitivity was 61.8% (43.6-77.8) and specificity was 84.5% (75.8-91.1). Two years of follow-up implied that higher SUVmax is correlated with higher recurrence risk, independent of conventional pathological findings. |
2 |
| 53. Ha HK, Koo PJ, Kim SJ. Diagnostic Accuracy of F-18 FDG PET/CT for Preoperative Lymph Node Staging in Newly Diagnosed Bladder Cancer Patients: A Systematic Review and Meta-Analysis. [Review]. Oncology. 95(1):31-38, 2018. |
Meta-analysis |
14 studies (785 patients) |
To assess the diagnostic accuracy of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for preoperative lymph node (LN) staging in newly diagnosed bladder cancer (BC) patients through a systematic review and meta-analysis. |
The pooled sensitivity was 0.57 (95% CI: 0.49-0.64) and the pooled specificity was 0.92 (95% CI: 0.87-0.95). The LR syntheses gave an overall LR+ of 7.4 (95% CI: 4.4-12.3) and an LR- of 0.47 (95% CI: 0.39-0.56). The pooled diagnostic odds ratio was 16 (95% CI: 9-28). |
Good |
| 54. Anjos DA, Etchebehere EC, Ramos CD, Santos AO, Albertotti C, Camargo EE. 18F-FDG PET/CT delayed images after diuretic for restaging invasive bladder cancer. J Nucl Med. 48(5):764-70, 2007 May. |
Observational-Dx |
17 patients |
To investigate the role of PET/CT in the detection and restaging of bladder cancer using furosemide and oral hydration. |
PET/CT detected 6/11 tumors in patients who had not undergone cystectomy. 7/17 patients were upstaged only after review of delayed pelvic images. |
3 |
| 55. Alongi P, Caobelli F, Gentile R, et al. Recurrent bladder carcinoma: clinical and prognostic role of 18 F-FDG PET/CT. Eur J Nucl Med Mol Imaging. 44(2):224-233, 2017 Feb. |
Observational-Dx |
41 patients |
To evaluate the accuracy, the effect upon treatment decision, and the prognostic value of 18F-fluorodeoxyglucose (FDG) PET/ Computedtomography (CT) in patients with suspected recurrent bladder carcinoma (BC) |
PET was considered positive in 21 of 41 patients. Of these, recurrent BC was confirmed in 20 (95 %). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG PET/CT were 87 %, 94 %, 95 %, 85 %, 90 %. AUC was 0.9 (95 %IC 0.8-1). Bayesian positive and negative likelihood ratios were 14.5 and 0.13, respectively. FDG PET/CT findings modified the therapeutic approach in 16 patients (modified therapy in 10 PET-positive patients,watch-and-wait in six PET-negative patients). PFS was significantly longer in patients with negative scan vs. those with pathological findings (85 % vs. 24 %, p < 0.05; HR= 12.4; p = 0.001). Moreover, an unremarkable study was associated with a longer OS (88 % vs. 47 % after 2 years and 87 % vs. 25 % after 3 years, respectively, p < 0.05). Standardized uptake value (SUV)max > 6 and total lesion glycolysis (TLG) > 8.5 were recognized as the most accurate thresholds to predict PFS (2-year PFS 62%for SUVmax < 6 vs. 15%for SUVmax > 6, p = 0.018; 2-year PFS 66 % for TLG < 8.5 vs. 18 % for TLG > 8.5, p = 0.09). |
2 |
| 56. Hillner BE, Siegel BA, Hanna L, et al. Impact of 18F-FDG PET used after initial treatment of cancer: comparison of the National Oncologic PET Registry 2006 and 2009 cohorts. J Nucl Med. 2012; 53(5):831-837. |
Review/Other-Dx |
Restaging or suspected recurrence (2006, n=30,911; 2009, n=54,747) chemotherapy monitoring (2006, n=10,234; 2009, n=15,611) |
To compare the impact of PET on intended management for the 7 most common cancer types that remained in NOPR after 2009 (bladder, kidney, pancreas, prostate, small cell lung, stomach, and uterus) and an aggregation of all other types for the periods before and after April 2009 (designated NOPR 2006 and NOPR 2009, respectively) when the use was categorized as subsequent treatment planning, including restaging or detection of suspected recurrence (henceforth collectively designated as restaging) or treatment monitoring. |
There were slight differences between time periods but little difference by cancer type or patient age within a time period. For restaging or suspected recurrence, comparing the 2006 and 2009 cohorts, total change in intended management for all cancer types was about 33% in those younger than age 65 and about 35% in those older than age 65 (range by cancer type, 31%–41%). The referring physician impression of disease extent (restaging) or prognosis (chemotherapy monitoring) after PET was similar between cohorts. In the 2009 cohort, PET for chemotherapy monitoring was associated with a 25% increase in plans to continue therapy and a complementary decline in plans to adjust therapy. The greatest management impact of PET was during chemotherapy monitoring in the 2009 cohort, where a post-PET prognosis judged to be worse than before PET was associated with a plan to discontinue that therapy in 90% and to change to a different therapy in 65%. |
4 |
| 57. van de Putte EEF, Vegt E, Mertens LS, et al. FDG-PET/CT for response evaluation of invasive bladder cancer following neoadjuvant chemotherapy. Int Urol Nephrol. 49(9):1585-1591, 2017 Sep. |
Observational-Dx |
47 patients included for response analysis. |
To investigate the accuracy of FDG-PET/CT response identification following neoadjuvant or induction chemotherapy (NAIC) for invasive bladder cancer (BC) as to better select patients for radical cystectomy (RC). |
Twenty-four cN+ patients achieved LN pCR. FDG-PET/CT identified pCR with 67% sensitivity and 46% specificity. Primary tumor response was evaluable for 17/23 patients, of whom 12 were responders. Tumor downstaging (pPR or pCR) was identified with 83% sensitivity and 80% specificity. Tumor pCR was detected with 70% sensitivity and 71% specificity. pCR of overall disease (primary tumor and LNs, n = 17) was detected with 67% sensitivity and 75% specificity. CSS was positively associated with pathologic CR (HR 0.16, p = 0.027), but not with metabolic CR (HR 0.560, p = 0.612). |
2 |
| 58. Soubra A, Gencturk M, Froelich J, et al. FDG-PET/CT for Assessing the Response to Neoadjuvant Chemotherapy in Bladder Cancer Patients. Clin Genitourin Cancer. 16(5):360-364, 2018 10. |
Observational-Dx |
37 patients |
To determine the accuracy of 18F-fluorodeoxyglucose with positron emission tomography and computed tomography (FDG-PET/CT) scans in assessing the response to neoadjuvant chemotherapy (NAC) in patients with bladder cancer scheduled to undergo radical cystectomy (RC). |
FDG-PET/CT had 75% sensitivity (89.66% specificity) in identifying those with complete pathologic response with a 100% change in SUVmax, and 83% sensitivity (94% specificity) for the detection of chemosensitive tumors. |
2 |
| 59. Kollberg P, Almquist H, Blackberg M, et al. [18F]Fluorodeoxyglucose-positron emission tomography/computed tomography response evaluation can predict histological response at surgery after induction chemotherapy for oligometastatic bladder cancer. Scand J Urol. 51(4):308-313, 2017 Aug. |
Observational-Dx |
45 patients |
To evaluate sequential FDG-PET/CT examinations as an indicator of chemotherapy response. |
Three patients showed progression to incurable disease during chemotherapy and another two patients did not undergo surgery, for medical reasons. Lymphadenectomy was performed in the remaining 45 patients, of whom 43 had lymph-node metastasis. FDG-PET/CT prediction of the histological nodal chemotherapy response was correct in 37 (86%) of those 43. The second FDG-PET/CT examination identified four out of nine non-responders. For response, the sensitivity, specificity, and positive and negative predictive values for FDG-PET/CT accuracy were 37 out of 37 (100%), one out of six (17%), 37 out of 42 (88%) and one out of one (100%), respectively. |
3 |
| 60. Picchio M, Treiber U, Beer AJ, et al. Value of 11C-choline PET and contrast-enhanced CT for staging of bladder cancer: correlation with histopathologic findings. J Nucl Med. 2006;47(6):938-944. |
Observational-Dx |
27 patients |
To compare the diagnostic accuracy of contrast enhanced CT with 11C-choline PET for the staging of bladder cancer. |
The presence of residual bladder cancer (pTa-pT4) was correctly detected in 21/25 histologically tumor-positive patients (84%) by CT and in 24/25 patients (96%) by 11C-choline PET. Lymph node involvement was correctly detected in 4/8 patients (50%) by CT and in 5/8 patients (62%) by 11C-choline PET. The median size of the 3 nodes with false-negative PET results was 9 mm (range, 6-21 mm), and the median size of the metastatic lesions within the lymph nodes was 3 mm (range, 1-15 mm). CT resulted in 6 (22%) false-positive lymph nodes, whereas none was demonstrated by 11C-choline PET; these data indicated a significantly higher accuracy of PET than of CT (P<0.01). Both modalities missed a small peritoneal metastasis verified by histologic evaluation. No positive results were obtained from bone scintigraphy. |
2 |
| 61. Woo S, Suh CH, Kim SY, Cho JY, Kim SH. The Diagnostic Performance of MRI for Detection of Lymph Node Metastasis in Bladder and Prostate Cancer: An Updated Systematic Review and Diagnostic Meta-Analysis. [Review]. AJR Am J Roentgenol. 210(3):W95-W109, 2018 Mar. |
Meta-analysis |
Twenty-four studies (2928 patients) were included. |
To review the diagnostic performance of MRI for the detection of pelvic lymph node (LN) metastasis in patients with bladder and prostate cancer. |
Pooled per-patient sensitivity (n = 21) was 0.56 (95% CI, 0.42-0.69) with a specificity of 0.94 (95% CI, 0.90-0.96). Per-LN pooled estimates (n = 9) showed consistent results: sensitivity of 0.57 (95% CI, 0.29-0.82) and specificity of 0.97 (95% CI, 0.94-0.98). At metaregression analysis, type of cancer, magnet field strength, and use of ultrasmall superparamagnetic particles of iron oxide (USPIO) were significant factors affecting heterogeneity (p = 0.01). Sensitivity analyses showed that specificity estimates were comparable (range, 0.87-0.95), but sensitivity estimates showed significant differences. Studies that used USPIO (n = 4) had higher sensitivity (0.86; 95% CI, 0.62-0.96) than did those not using USPIO (n = 17; 0.46; 95% CI, 0.35-0.58). |
Good |
| 62. Nishimura K, Fujiyama C, Nakashima K, Satoh Y, Tokuda Y, Uozumi J. The effects of neoadjuvant chemotherapy and chemo-radiation therapy on MRI staging in invasive bladder cancer: comparative study based on the pathological examination of whole layer bladder wall. Int Urol Nephrol. 2009; 41(4):869-875. |
Observational-Dx |
27 patients |
To evaluate the correlation of radiological findings obtained by MRI study with pathological diagnosis in invasive bladder cancer treated with neoadjuvant chemotherapy, with or without radiation. |
Tumor stage assessed by MRI was consistent with pathological findings in 16/27 cases (59.3%), while MRI produced overstaging in 7 cases and understaging in 4 cases. The accuracy of staging was 75.0%, 30.0%, and 77.8% in groups A, B, and C, respectively. The accuracy of MRI staging in group B was lower than that in group C (P<0.05). There was no difference in the accuracy of MRI staging between groups A and C. |
3 |
| 63. Yoshida S, Koga F, Kawakami S, et al. Initial experience of diffusion-weighted magnetic resonance imaging to assess therapeutic response to induction chemoradiotherapy against muscle-invasive bladder cancer. Urology. 2010; 75(2):387-391. |
Observational-Dx |
20 patients |
To investigate the feasibility of DWI-MRI in predicting therapeutic response to low-dose chemoradiotherapy against muscle-invasive bladder cancer. |
Pathologic examination of cystectomy specimens revealed pathologic complete response in 13 (65%) of the 20 patients. The sensitivity/specificity/accuracy of T2-weighted, DCE, and DWI in predicting pathologic response was 43%/45%/44%, 57%/18%/33%, and 57%/92%/80%, respectively. Despite comparable sensitivity, DWI was significantly superior in specificity and accuracy to T2-weighted (P=.03 and .02, respectively) and DCE (P=.002 for both). |
3 |
| 64. Jinzaki M, Matsumoto K, Kikuchi E, et al. Comparison of CT urography and excretory urography in the detection and localization of urothelial carcinoma of the upper urinary tract. AJR Am J Roentgenol. 2011; 196(5):1102-1109. |
Observational-Dx |
104 patients and 552 urinary tract segments |
To compare the accuracy of CTU and excretory urography for the detection and localization of upper urinary tract urothelial carcinoma. |
Upper urinary tract urothelial carcinoma was diagnosed in 77 (14%) segments of 46 (44%) patients. Per-patient sensitivity, specificity, overall accuracy, and area under the receiver operating characteristic curves for detecting carcinomas with CTU (93.5% [43/46], 94.8% [55/58], 94.2% [98/104], and 0.963, respectively) were significantly greater than those for excretory urography (80.4% [37/46], 81.0% [47/58], 80.8% [84/104], and 0.831, respectively) (P=0.041, P=0.027, P=0.001, and P<0.001, respectively). Per-segment sensitivity and overall accuracy for the localization of upper urinary tract urothelial carcinoma were significantly greater with CTU (87.0% [67/77] and 97.8% [540/552]) than with excretory urography (41.6% [32/77] and 91.5% [505/552]) (P<0.0001). |
3 |
| 65. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
