Management of clinical T1 bladder transitional cell carcinoma by radical cystectomy

Fernando J. Bianco, Daniel Justa, David Grignon, Wael A. Sakr, J. Edson Pontes, David P. Wood

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

High-grade bladder cancer involving the lamina propria is considered superficial disease. This spectrum is generally treated with TUR plus intravesical therapy. However, significant understaging jeopardizes long-term survival and improvements and radical surgery represents a provocative alternative. We evaluated disease-free and cancer-specific survival (CSS) in our cohort of patients with high-grade T1 tumors. A total of 318 patients with bladder cancer underwent radical cystectomy between 1990 and 2000 at our institution. Of these, 66 had cT1 tumors with or without Carcinoma in-situ (CIS). Our multidisciplinary bladder cancer database was queried to perform a multivariate analysis on clinical parameters such as: age, race, sex, cystectomy year, intravesical therapy, angiolymphatic-invasion and tumor upstage in relation to recurrence and survival. The clinical stage was accurate in 44 of the cases (66%). However, 27% were upstaged by cystectomy and 12% of the cT1 + CIS patients had nodal disease. Patients with cT1 tumors plus CIS had a significantly worse CSS. Those with persistent disease after an initial course of BCG therapy appeared to have worse CSS also. At a median follow up of 4 years, overall cancer-specific mortality was 22%, however, pathologic T1 ± CIS had 92% CSS at 10 years. Our data suggests that some cT1 bladder cancer tumors have assiduous clinical courses evidenced in staging discrepancies. For high-grade tumors, early cystectomy and orthotopic diversion increases life expectancy significantly and should be carry out early rather than late.

Original languageEnglish (US)
Pages (from-to)290-294
Number of pages5
JournalUrologic Oncology: Seminars and Original Investigations
Volume22
Issue number4
DOIs
StatePublished - Jul 2004
Externally publishedYes

Fingerprint

Transitional Cell Carcinoma
Cystectomy
Urinary Bladder
Urinary Bladder Neoplasms
Carcinoma in Situ
Neoplasms
Survival
Mycobacterium bovis
Life Expectancy
Mucous Membrane
Therapeutics
Multivariate Analysis
Databases
Recurrence
Mortality

Keywords

  • Bladder cancer
  • CIS
  • Superficial
  • Survival
  • Understaging

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Management of clinical T1 bladder transitional cell carcinoma by radical cystectomy. / Bianco, Fernando J.; Justa, Daniel; Grignon, David; Sakr, Wael A.; Pontes, J. Edson; Wood, David P.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 22, No. 4, 07.2004, p. 290-294.

Research output: Contribution to journalArticle

Bianco, Fernando J. ; Justa, Daniel ; Grignon, David ; Sakr, Wael A. ; Pontes, J. Edson ; Wood, David P. / Management of clinical T1 bladder transitional cell carcinoma by radical cystectomy. In: Urologic Oncology: Seminars and Original Investigations. 2004 ; Vol. 22, No. 4. pp. 290-294.
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