School of Medicine; Senior Scholars Program
Joaquim Bellmunt (Dana Farber)
Adult; Aged; Aged, 80 and over; Carcinoma in Situ; Carcinoma, Squamous Cell; Cohort Studies; *Cystectomy; Female; Humans; Male; Middle Aged; Mucous Membrane; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Reoperation; Urinary Bladder Neoplasms; Urinary Tract
Neoplasms | Oncology | Urology
BACKGROUND: Management of high-grade T1 (HGT1) bladder cancer represents a major challenge. We studied a treatment strategy according to substaging by depth of lamina propria invasion.
METHODS: In this prospective observational cohort study, patients received initial transurethral resection (TUR), mitomycin-C, and BCG. Subjects with shallower lamina propria invasion (HGT1a) were followed without further surgery, whereas subjects with HGT1b received a second TUR. Association of clinical and histological features with outcomes (primary: progression; secondary: recurrence and cancer-specific survival) was assessed using Cox regression.
RESULTS: Median age was 71 years; 89.5% were males, with 89 (44.5%) cases T1a and 111 (55.5%) T1b. At median follow-up of 71 months, disease progression was observed in 31 (15.5%) and in univariate analysis, substaging, carcinoma in situ, tumour size, and tumour pattern predicted progression. On multivariate analysis only substaging, associated carcinoma in situ, and tumour size remained significant for progression.
CONCLUSIONS: In HGT1 bladder cancer, the strategy of performing a second TUR only in T1b cases results in a global low progression rate of 15.5%. Tumours deeply invading the lamina propria (HGT1b) showed a three-fold increase in risk of progression. Substaging should be routinely evaluated, with HGT1b cases being thoroughly evaluated for cystectomy. Inclusion in the TNM system should also be carefully considered.
high risk bladder cancer, HGT1, substaging, reTUR, prognosis
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DOI of Published Version
Br J Cancer. 2015 Feb 3;112(3):468-74. doi: 10.1038/bjc.2014.633. Epub 2014 Dec 23. Link to article on publisher's site
British journal of cancer
Orsola, Anna; Werner, L; de Torres, I; Martin-Doyle, William; Raventos, C X.; Lozano, F; Mullane, S A.; Leow, J J.; Barletta, J A.; Bellmunt, Joaquim; and Morote, J, "Reexamining treatment of high-grade T1 bladder cancer according to depth of lamina propria invasion: a prospective trial of 200 patients" (2015). University of Massachusetts Medical School. Senior Scholars Program. Paper 215.
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This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License.