Senior Scholars Program

UMMS Affiliation

School of Medicine; Senior Scholars Program

Faculty Advisor

Joaquim Bellmunt (Dana Farber)

Publication Date

2015-02-03

Document Type

Article

Subjects

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

Disciplines

Neoplasms | Oncology | Urology

Abstract

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.

Keywords

high risk bladder cancer, HGT1, substaging, reTUR, prognosis

Rights and Permissions

From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/

DOI of Published Version

10.1038/bjc.2014.633

Source

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

Comments

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

25535728

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.

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