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UROLOGICAL
ONCOLOGY
doi: 10.1590/S1677-553820100002000026
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
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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
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