Reexamining treatment of high-grade T1 bladder cancer according to depth of lamina propria invasion: a prospective trial of 200 patients

• Published in: British journal of cancer Vol. 112; no. 3; pp. 468 - 474
• Main Authors: Orsola, A, Werner, L, de Torres, I, Martin-Doyle, W, Raventos, C X, Lozano, F, Mullane, S A, Leow, J J, Barletta, J A, Bellmunt, J, Morote, J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 03.02.2015; Nature Publishing Group
• Subjects: 631/80/84/2336; 692/699/67/1059; 692/699/67/322; 692/699/67/589/1336; Adult; Aged; Aged, 80 and over; Biomedical and Life Sciences; Biomedicine; Cancer Research; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Clinical Study; Cohort Studies; Cystectomy; Drug Resistance; Epidemiology; Female; Humans; Male; Middle Aged; Molecular Medicine; Mucous Membrane - pathology; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Recurrence, Local - surgery; Oncology; Reoperation; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urinary Tract - pathology; reTUR; high risk bladder cancer; HGT1; prognosis; substaging
• ISSN: 0007-0920; 1532-1827; 1532-1827
• DOI: 10.1038/bjc.2014.633

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.