UROLOGICAL SURVEY
Urological oncology
Characteristics and outcomes of patients with clinical t1 grade 3 urothelial carcinoma treated with radical cystectomy: results from an international cohort
Fritsche HM, Burger M, Svatek RS, Jeldres C, Karakiewicz PI, Novara G, Skinner E, Denzinger S, Fradet Y, Isbarn H, Bastian PJ, Volkmer BG, Montorsi F, Kassouf W, Tilki D, Otto W, Capitanio U, Izawa JI, Ficarra V, Lerner S, Sagalowsky AI, Schoenberg M, Kamat A, Dinney CP, Lotan Y, Shariat SF
Caritas-St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
Eur Urol. 2010; 57: 300-9
BACKGROUND: Management of T1 grade 3 (T1G3) urothelial carcinoma of the bladder (UCB), with its variable behaviour, represents one of the most difficult challenges for urologists and patients alike.
OBJECTIVE: To evaluate the characteristics and long-term outcome of patients with clinical T1G3 UCB treated with radical cystectomy (RC).
DESIGN, SETTING, AND PARTICIPANTS: Data from 1136 patients treated with RC for clinical T1G3 UCB without neoadjuvant chemotherapy were collected at 12 centres located in Europe, the United States, and Canada. Median age was 67 yr (range: 29-94), with a male-to-female ratio of 4:1.
MEASUREMENTS: Patients' characteristics and outcome are evaluated.
RESULTS AND LIMITATIONS: Of the 1136 patients, 33.4% had non-organ-confined stage at cystectomy, and 16.2% had lymph node (LN) metastasis; 49.7% were upstaged after RC to muscle-invasive disease, while 21.4% were downstaged to lower than T1G3. Within a median follow-up of 48 mo, 35.5% of patients died of metastatic UCB.
CONCLUSIONS: Approximately half of the patients treated with RC without neoadjuvant chemotherapy for clinical T1G3 UCB are upstaged to muscle-invasive UCB. These rates support the inadequacy of clinical decision making based on current treatment paradigms and staging tools. Therefore, identification of patients with clinical T1G3 disease at high risk of disease progression is of the utmost importance, as these patients are likely to benefit from early RC.
Editorial Comment
The optimal primary treatment of stage and grade T1G3 bladder cancer, radical or conservative, is a matter of debate since years. Here, 12 international centers with a large experience in radical cystectomies present their data on this aggressive "borderline" tumor. They found a high rate of nearly 50% of tumor upstaging to muscle invasive disease.
Alas, this study suffers from several drawbacks. No indication on previous intravesical therapy, or on the time between first diagnosis of bladder cancer and cystectomy are given. These data would have made it much easier to judge on the delay as reason for the high rate of upstaging and to get information on the proportion of "true aggressive" T1G3 tumors which would indeed need immediate cystectomy without an initial trial of TUR, re-TUR and BCG.
All in all, these data reflect the aggressive nature of T1G3 bladder cancer and the need for stringent management, be it conservative or radical.
Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: boehle@urologie-bad-schwartau.de
Publication Dates
-
Publication in this collection
31 May 2010 -
Date of issue
Apr 2010
