Stage T1, Grade 3 Transitional Cell Carcinoma of the Bladder: An Unfavorable Tumor?

Abstract

Transurethral resection only was performed in 172 patients with initial stage Ta, T1 transitional cell carcinoma of the bladder. Additional treatment during the course of disease was given to 9 patients with carcinoma in situ and to 8 patients with tumor progression. The mean followup was 106 months. The 10-year survival rates were 95 per cent for patients with stage Ta, grade 1 disease, 89 per cent for stage Ta, grade 2, 84 per cent for stage Ta, grade 3, 78 per cent for stage T1, grade 2 and 50 per cent for stage T1, grade 3. The percentage of first tumor recurrence at the same site increased with tumor grade (stage T1, grade 3 was 74 per cent). The recurrence rate in stage T1, grade 3 tumors (4.08) differed significantly from the other groups of superficial tumors. The tumor progression rate for stage T1, grade 3 tumors (32.5 per cent) was significantly higher as well. The characteristics of stage T1, grade 3 tumors with and without progression were different in regard to multiplicity, recurrence rate, mean interval to recurrence and type of tumor invasion. Of the 13 patients who died of progressive neoplastic disease 11 presented initially with stage T1, grade 3 tumors. When these results are considered it is obvious that a patient with a stage T1, grade 3 tumor deserves additional therapy, such as chemotherapy, immunotherapy or phototherapy.

Update on the management of non-muscle invasive bladder cancer

“…High-grade Ta tumours account for only 2% to 9% of all cases of NMIBC. 16,17 Holmang and colleagues demonstrated that low-grade Ta tumours had a recurrence of 70%, with a progression of only 2%. 18 Heney and colleagues showed that the risk of progression to muscle invasion is strongly associated with tumour grade.…”

Low-Dose BCG Instillations in the Treatment of Stage T1 Grade 3 Bladder Tumours: Recurrence, Progression and Success

“…In fact, tumour grade may influence recurrence and progression [3]. T1 G3 tumours in particular are known to have a poor prognosis (from 50 to 70% of recurrence) [4]. …”

A mathematical model for predicting tumor recurrence within 24 months following surgery in patients with T1 high-grade bladder cancer treated with BCG immunotherapy

“…Two major options are available for the management of patients with T1HG tumors: TURBT followed by intravesical therapy, or immediate radical cystectomy. Immediate cystectomy may give the advantage of long term cancer cure; however, it is considered an over-treatment in several cases [15] and carries serious impairment on patient's quality of life, in addition to high morbidity and mortality rates, not less than cystectomy done for invasive disease [16]. Considering survival, Kulkarni et al estimated that a healthy 60 years-old patient undergoing cystectomy for high risk non-muscle invasive disease has a life expectancy of 14.29 yrs compared to 13.63 yrs in similar patient undergoing conservative management [17].…”