In Tunisia, bladder cancer represents the first urological cancer before
even prostate cancer. However, its diagnosis is often delayed to the stage of
invasive tumor. Systemic chemotherapy represents an option for inoperable
and/or metastatic forms. Our study’s aims were to report our center’s therapeutic
results for locally advanced and metastatic forms of bladder cancer and to
analyze its prognosis factors. In our 40 patients with bladder cancer advanced
stages (locally advanced and metastatic), transitional cell carcinoma was the
most common histological type (82.5%); mean age at diagnosis was 63.3 ± 10.5
years with a sex ratio equal to 12.3; radical cystectomy and radiation therapy
were performed separately both in 35% of cases and chemotherapy in 60%;
cisplatin associated with gemcitabine was the most used regimen and navelbine monotherapy was used as
second-line chemotherapy; median overall survival was 14.4 months, and its influencing
factors according to our results were: ECOG score, T and M tumor stages,
primary tumor surgery and adjuvant chemotherapy.
Cite this paper
Sonia, Z. , Wiem, K. , Rim, B. , Ibtissem, A. , Kamel, K. , Yosri, B. A. and Amira, D. (2017). Therapeutic Specificities and Prognosis of Advanced Stage and Metastatic Bladder Cancers in a Tunisian University Hospital. Open Access Library Journal, 4, e3894. doi: http://dx.doi.org/10.4236/oalib.1103894.
Jacons, B.L., Lee, C.T. and Montie, J.E. (2010) Bladder Cancer in 2010: How Far Have We Come? CA: A Cancer Journal for Clinicians, 60, 244-272. https://doi.org/10.3322/caac.20077
Stenzl, A., Witfies, J.A., Cowan, N.C., De Santis, M., Lebret, T., Merseburger, A.S., et al. (2011) Guidelines on Bladder Cancer Muscle Invasive and Metastatic. European Urology, 59, 1009-1018. https://doi.org/10.1016/j.eururo.2011.03.023
Ministry of Public Health, Institute Salah Azaiez, Service of Epidemiology, Biostatistics and Medical Informatics. Register of the Institute Salah Azaiez 1994-1999: 105-107.
Houede, N., Locker, G., Lucas, C., Soto Parra, H., Basso, U., Spaeth, D., et al. (2016) Epicure: European Epidemiology Study of Patients with an Advanced or Metastatic Urothelial Carcinoma Having Progressed to Platinium-Based Chemotherapy. BMC Cancer, 16, 752. https://doi.org/10.1186/s12885-016-2782-3
Serhal, A. (2010) The Superficial Tumors of the Urinary Bladder PT1G3: Diagnostic, Therapeutic and Prognostic Aspects: About 40 Cases. Medical Thesis Monastir Medicine.
Aouni, A. (2007) Les tumeurs superficielles de la vessie PT1G3: Aspects diagnostiques, thérapeutiques et pronostiques. A propos de 40 cas. [The Superficial Tumors of the Bladder PT1G3: Diagnostic, Therapeutic and Prognostic Aspects. About 40 Cases]. Thèse Médecine Monastir.
Witjes, J.A., Lebret, T., Compérat, E.M., Cowan, N.C., De Santis, M., Bruins, H.M., et al. (2016) Updated 2016 EAU Guidelines on Muscle-Invasive and Metastatic Bladder Cancer. European Urology, 71, 462-475.
Bjerregaard, B.K., Raaschou-Nielson, O., Sorensen, M. and Frederiksen, K. (2006) Tobacco Smoke and Bladder Cancer in the European Prospective Investigation into Cancer and Nutrition. International Journal of Cancer, 119, 412-416. https://doi.org/10.1002/ijc.22169
Brennan, P., Bogillot, O., Cordier, S., Greiser, E. and Schill, W. (2000) Cigarette Smoking and Cancer of the Bladder in Men: A Pooled Analysis of 11 Case-Control Studies. International Journal of Cancer, 82, 289-294. https://doi.org/10.1002/(SICI)1097-0215(20000415)86:2<289 ::AID-IJC21>3.0.CO;2-M
Gandini, S., Botteri, E., Iodice, S., Boniol, M., Lowenfels, A.B., Maisonneuve, P. and Boyle, P. (2008) Smoking and Cancer: A Meta-Analysis. International Journal of Cancer, 122, 155-164. https://doi.org/10.1002/ijc.23033
Riou, O., Chauvet, B., Lagrange, J.L., Martin, P., Moscardo, C.L., Charissoux, M., et al. (2016) Radiotherapy of Cancers of the Bladder. Cancer Radiother.
Shipley, W.U., Winter, K.A., Kaufman, D.S., Lee, W.R., Heney, N.M., Tester, W.R., et al. (1998) Phase III Trial of Neoadjuvant Chemotherapy in Patients with Invasive Bladder Cancer Treated with Selective Bladder Preservation by Combined Radiation Therapy and Chemotherapy Initial Results of Radiation Therapy Oncology Group 89-03. Journal of Clinical Oncology, 16, 3576-3583. https://doi.org/10.1200/JCO.1998.16.11.3576
Cowan, R.A., Mc Bain, C.A., Ryder, W.D., et al. (2004) Radiotheraoy for Muscle Invasive Carcinoma of the Bladder: Results of a Randomized Trial Comparing Conventional Whole Bladder with Dose-Escalated Partial Bladder Radiotherapy. International Journal of Radiation Oncology Biology Physics, 59, 197-207.
Smith, J.A., Crawford, E.D., Paradelo, J.C., Blumenstein, B., Herschman, B.R., Grossman, H.B., et al. (1997) Treatment of Advanced Bladder Cancer with Combined Preoperative Irradiation and Radical Cystectomy versus Radical Cystectomy Alone: A Phase III Intergroup Study. Journal of Urology, 157, 805-807.
Huncharek, M., Muscat, J. and Geschwind, J.F. (1998) Planned Preoperative Radiation Therapy in Muscle Invasive Bladder Cancer: Results of a Meta-Analysis. Anticancer Research, 18, 1931-1934.
Sherif, A., Holmberg, L., Rintala, E., Mestad, O., Nilsson, O., Nilsson, J., et al. (2004) Neoadjuvantcisplatinium Based Combination Chemotherapy in Patients with Invasive Bladder Cancer: A Combined Analysis of Two Nordic Studies. European Urology, 45, 297-303.
Sternberg, C.N., Yagoda, A., Scher, H.I., Watson, R.C., et al. (1989) Methotrexate, Vinblastine, Doxorubicin and Cisplatin for Advanced Transitional Cell Carcinoma of the Urothelium. Efficacy and Patterns of Response and Relapse. Cancer, 64, 2448-2458. https://doi.org/10.1002/1097-0142(19891215)64:12<2448:: AID-CNCR2820641209>3.0.CO;2-7
Von der Maase, H., Hansen, S.W. and Roberts, J.T. (2000) Gemcitabine and Cisplatine (GC) versus Methotrexate, Vinblastine Adriamycin and Cisplatin (MVAC) Chemotherapy in Advanced or Metastatic Transitional Cell Carcinoma (TCC) of the Urothelium: A Large Randomized Multicenter, Multinational Phase III Study. American Society of Clinical Oncology, 19, 329.
Sternberg, C.N., de Mulder, P., Schornagel, J.H., Theodore, C., Fossa, S.D., van Oosterom, A.T., et al. (2006) Seven Year Update of an EORTC Phase III Trial of High-Dose Intensity M-VAC Chemotherapy and G-CSF versus Classic M-VAC in Advanced Urothelial Tract Tumours. European Journal of Cancer, 42, 50-54.
Maha, H., Hussain, A., Wood, D.P., et al. (2009) Bladder Cancer: Narrowing the Gap between Evidence and Practice. Journal of Clinical Oncology, 27, 5680-5684.
Cussenot, O. and Ravery, V. (1995) Classifications and Prognostic Factors of Epithelial Tumors of the Bladder. EMC (Paris-France), Néphrologie-Urologie, 18-243-A-20, 5 p.
Kaufman, D.S., Shilpey, W.U. and Griffin, P.P. (1993) Selective Bladder Preservation by Combined Modality Treatment of Invasive Bladder Cancer. The New England Journal of Medicine, 329, 1377-1381. https://doi.org/10.1056/NEJM199311043291903
Wityes, J.A., Umbas, R., Debrayne, F.M. and Schalnen, J.A. (1995) Expression of Markers for Transitional Cell Carcinoma in Bladder Mucosa of Patients with Bladder Cancer. Journal of Urology, 154, 218-219.
