A multicolour fluorescence in situ hybridization test predicts recurrence in patients with high-risk superficial bladder tumours undergoing intravesical therapy.
OBJECTIVE
To determine whether a multicolour fluorescence in situ hybridization test (UroVysion, Abbott Molecular Inc., Des Plaines, IL, USA) in patients with high-risk superficial bladder tumours maintains its predictive ability in a multivariate model for recurrence and progression, incorporating clinical and pathological predictors of outcome.


METHODS
The charts of patients with superficial bladder cancer treated with induction or maintenance intravesical therapy (IVT) were reviewed retrospectively. UroVysion testing was used at the beginning and end of each IVT cycle, and cytology and cystoscopy 6 weeks after completing each cycle. Kaplan-Meier actuarial survival was analysed, stratified by the UroVysion result after IVT. Univariate and multivariate Cox regression analyses were used to identify significant predictors of recurrence.


RESULTS
In all, 42 patients had induction IVT with bacille Calmette-Guérin (BCG), BCG + interferon, or mitomycin. The median follow-up was 21 months. Recurrent disease was detected in 18 patients. In a univariate analysis, chronic renal insufficiency (hazard ratio 12.1, P = 0.03), positive cytology after IVT (2.7, P = 0.05), and a positive UroVysion test after IVT (8.3, P < 0.01) were predictive of failure. In the multivariate analysis, high grade disease (5.3, P = 0.05), a risk score of >6 (4.7, P = 0.02) and a positive UroVysion test after IVT (6.7, P < 0.01) were significant predictors of recurrence.


CONCLUSIONS
In patients with high-risk superficial bladder tumours undergoing IVT, a positive UroVysion test after treatment is highly predictive of recurrence, even in a multivariate model. Additional adjuvant therapy might be necessary in these patients to improve the outcome.
Whitson
Jared
J
Department of Urology, University of California San Francisco, San Francisco, CA 94123, USA. jwhitson@urology.ucsf.edu
Berry
Anna
A
Carroll
Peter
P
Konety
Badrinath
B
D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000008:administration & dosage; D004812:Epidemiologic Methods; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods* / Q000592:standards; D007372:Interferons / Q000008:administration & dosage; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology
D001500:BCG Vaccine; D016685:Mitomycin; D007372:Interferons