Clinical Outcomes of cT1 Micropapillary Bladder Cancer

Abstract

Purpose While many urologists recommend radical cystectomy for patient with micropapillary bladder cancer (MPBC) invading the lamina propria (cT1), contradictory small reports exist regarding the efficacy of conservative management with intravesical BCG for this disease. Herein we report our updated experience with largest series of patients with cT1 MPBC. Materials and Methods An IRB approved review of our cancer database identified 283 patients with MPBC, including 72 staged as cT1N0M0 at diagnosis and initiation of therapy. Survival analysis was performed using Kaplan-Meier estimator and compared using the log-rank test. Results Within this 72 patient cohort, 40 received primary intravesical BCG and 26 underwent upfront radical cystectomy. Patients receiving BCG experienced high rates of disease recurrence (75%) and progression (45%); 35% developed lymph node metastasis. Patients treated with upfront cystectomy had improved survival compared to patients treated with primary BCG (5 year disease specific survival (DSS) of 100% vs. 60% respectively, p=0.006) or patients undergoing delayed cystectomy after recurrence (5 yr. DSS: 62%, p=0.015). Prognosis was especially poor in patients who waited for progression prior to undergoing radical cystectomy, with an estimated 5-year DSS of only 24% and a median survival of 35 months. In patients treated with upfront cystectomy, pathologic upstaging occurred in 27%, including 20% with lymph node metastasis. Conclusions While certain patients with T1 MPBC may respond to intravesical BCG, improved survival is seen in those patients who undergo early radical cystectomy. Further molecular studies are needed to identify subsets of patients able to spare their bladders safely.

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