Bladder preservation or initial cystectomy in T1G3 bladder cancer: which parameters help in therapeutic decision-making?

• Published in: Aktuelle Urologie Vol. 39; no. 1; p. 58
• Main Authors: Denzinger, S, Burger, M, Fritsche, H-M, Ganzer, R, Blana, A, Wieland, W F, Otto, W
• Format: Journal Article
• Language: German
• Published: Germany 01.01.2008
• Subjects: Adjuvants, Immunologic - administration & dosage; Adult; Aged; Aged, 80 and over; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Cystectomy; Data Interpretation, Statistical; Follow-Up Studies; Humans; Middle Aged; Mycobacterium bovis - immunology; Neoadjuvant Therapy; Neoplasm Staging; Postoperative Care; Prognosis; Proportional Hazards Models; Reoperation; Risk Factors; Time Factors; Urinary Bladder - pathology; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery
• ISSN: 0001-7868
• DOI: 10.1055/s-2007-980147

T1G3 bladder cancers show the clinical and biological behaviour of muscle invasive tumours with progression rates of about 30%. While radical cystectomy in some cases is indicated, other patients can achieve healing with organ preservation. We present a study analysing the influence of the risk factors multifocality, tumour diameter >or= 3 cm and associated carcinoma in situ (Cis) on the outcome of initial T1G3 bladder cancers treated in various ways. Of 223 patients with initial T1G3 bladder cancer, 125 patients underwent transurethral resection of the tumour (TURB), second resection and adjuvant bacille Calmette-Guérin (BCG) instillations (TURB group), 98 patients chose initial radical cystectomy (CX group). Median follow-up times were 56 months (TURB group) and 51 months (CX group). 5- and 10-year survival rates (82% and 65% in TURB group vs. 75% and 48% in CX group) did not show statistically significant differences. In Cox regression analysis no single risk factor showed a prognostic value. While in TURB group the combination of all risk factors (multifocality, tumour diameter >or= 3 cm and associated carcinoma in situ) was associated with a statistically significantly lower survival rate, the same combination in the CX group was not oncologically relevant. While initial T1G3 bladder cancer with up to two risk factors after organ-preserving therapy is not associated with a lower tumour specific survival rate in comparison to radical cystectomy, patients with a combination of the three analysed risk factors would profit by an early radical cystectomy.