UMMS Affiliation

School of Medicine; Senior Scholars Program

Faculty Mentor

Joaquim Bellmunt (Dana Farber)

Publication Date


Document Type



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

Journal/Book/Conference Title

British journal of cancer


William Martin-Doyle participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID


Creative Commons License

Creative Commons Attribution-Noncommercial-Share Alike 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License.