Invasive T1 bladder cancer: indications and rationale for radical cystectomy

Stein, John P.; Penson, David F.

doi:10.1111/j.1464-410x.2008.07743.x

Cited by 48 publications

(35 citation statements)

References 37 publications

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“…The high rates of progression and mortality seen in past studies have spurred clinicians to advocate early definitive, radical surgery for patients with HGT1 disease, particularly if they have certain high-risk features (2,8,11,12). Despite no randomized trials, multiple retrospective studies have shown advantages for disease-specific and overall survivals in patients treated with RC before muscle invasion occurs (13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

“…HGT1 bladder cancer represents a heterogeneous disease with varying phenotypes and outcomes, and currently no test or validated scoring system exists to predict which patients would benefit most from an early RC (8). Thus, this study re-examines the natural history of HGT1 bladder cancer by analyzing the recurrence and progression rates of a large cohort of patients initially diagnosed with HGT1 disease to determine if, in fact, the high incidence of disease progression and death due to bladder cancer is still witnessed in a more contemporary treatment era.…”

Section: Introductionmentioning

confidence: 99%

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Re-examination of the Natural History of High-grade T1 Bladder Cancer using a Large Contemporary Cohort

Canter¹,

Revenig

Smith

et al. 2014

Int. braz j urol.

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ARTICLE INFO ______________________________________________________________ ______________________Introduction: High-grade T1 (HGT1) bladder cancer represents a clinical challenge in that the urologist must balance the risk of disease progression against the morbidity and potential mortality of early radical cystectomy and urinary diversion. Using two non-muscle invasive bladder cancer (NMIBC) databases, we re-examined the rate of progression of HG T1 bladder cancer in our bladder cancer populations. Materials and Methods:We queried the NMIBC databases that have been established independently at the Atlanta Veterans Affairs Medical Center (AVAMC) and the University of Pennsylvania to identify patients initially diagnosed with HGT1 bladder cancer. Demographic, clinical, and pathologic variables were examined as well as rates of recurrence and progression.Results: A total of 222 patients were identified; 198 (89.1%) and 199 (89.6%) of whom were male and non-African American, respectively. Mean patient age was 66.5 years. 191 (86.0%) of the patients presented with isolated HG T1 disease while 31 (14.0%) patients presented with HGT1 disease and CIS. Induction BCG was utilized in 175 (78.8%) patients. Recurrence occurred in 112 (50.5%) patients with progression occurring in only 19 (8.6%) patients. At a mean follow-up of 51 months, overall survival was 76.6%. Fifty two patients died, of whom only 13 (25%) patient deaths were bladder cancer related. Conclusions: In our large cohort of patients, we found that the risk of progression at approximately four years was only 8.6%. While limited by its retrospective nature, this study could potentially serve as a starting point in re-examining the treatment algorithm for patients with HG T1 bladder cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Re-examination of the Natural History of High-grade T1 Bladder Cancer using a Large Contemporary Cohort

Canter¹,

Revenig

Smith

et al. 2014

Int. braz j urol.

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“…2,23 As a result, some studies advocate initial cystectomy based on the perceived acceptable morbidity and a 5-year disease-specific survival rate of 80% to 90%. [24][25][26][27][28] However, the paucity of effective conservative treatment alternatives for stage T1 disease may be misinterpreted as an immediate mortality risk in patients who continue to exhibit organ-confined disease. As we will discuss later, an initial trial of BCG rather than immediate cystectomy appears justified in almost all initial T1Hg cases without undue risk, since progression within the first six months is rare (less than 4%).…”

Section: Patient Counsellingmentioning

confidence: 99%

The optimal management of T1 high-grade bladder cancer

Nepple

O’Donnell²

2013

CUAJ

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Stage T1Hg bladder cancer should be considered an aggressive and potentially lethal disease. The importance of initial re-resection to identify unrecognized muscle-invasive disease is significant. Most patients with high-risk disease are candidates for initial bladder salvage with intravesical bacillus Calmette-Guerin vaccine for immunotherapy, a procedure with a high survival rate; however, failure of the procedure may result in a guarded prognosis. Even after apparent success, patients should be informed of the risks of the disease progressing to muscle-invasive or metastatic disease and the need for vigilant monitoring. Despite optimal management, a significant number of patients relapse or progress to invasive disease requiring cystectomy. This review provides insight into the optimal management of T1 high-grade bladder cancer.Can Urol Assoc J 2009;3(Suppl4):S188-92

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“…T1 tumors are generally high grade, with a high risk of progression and/or metastasis. Progression rate is 20 to 40% in low grade T1 tumors treated by TUR only (Nieder et al, 2005;Stein and Penson, 2008). Progression and recurrence rates of high-grade T1 tumors are reported to be 60% and 80%, respectively (Heney, 1992).…”

Section: Introductionmentioning

confidence: 99%

Can Recurrence and Progression be Predicted by HYAL-1 Expression in Primary T1 Bladder Cancer?

Mammadov

Aslan²,

Tuna³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: Molecular prognostic markers have been under investigation for the last decade and no validated marker to date has been proven to be used in daily clinical practice for urinary bladder cancers. The aim of the present study is to evaluate the significance of HYAL-1 expression in prediction of recurrence and progression in pT1 urothelial carcinomas. Materials and Methods: Eighty-nine urothelial carcinoma cases staged as T1 according to 2004 WHO classification were studied. Representative sections from every case were stained immunohistochemically for HYAL-1 and scored between 0 and +3, according to staining density, and graded as low and high for the scores 0-1 and 2-3, respectively. Results: Of the 89 pT1 bladder cancer patients, HYAL-1 expression was high in 92.1% (82 patients; 72 patients +3 and 10 patients +2) and low in 7.9% (only 7 patients; 6 patients +1 and 1 patient 0) of the cases. Of the 89 patients, 38 (42.7%) had recurrence and 22 (24.7%) showed progression. HYAL-1 staining did not show significant characteristics for tumor grade, accompanying CIS, multiplicity, tumor size, age and sex. HYAL-1 expression did not have any prognostic value in estimating recurrence or progression. Conclusions: HYAL-1 expression was found to be high, but did not have any prognostic importance in T1 bladder urothelial carcinomas.

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Invasive T1 bladder cancer: indications and rationale for radical cystectomy

Cited by 48 publications

References 37 publications

Re-examination of the Natural History of High-grade T1 Bladder Cancer using a Large Contemporary Cohort

Re-examination of the Natural History of High-grade T1 Bladder Cancer using a Large Contemporary Cohort

The optimal management of T1 high-grade bladder cancer

Can Recurrence and Progression be Predicted by HYAL-1 Expression in Primary T1 Bladder Cancer?

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