Delayed Cystectomy Increases The Risk Of Systemic Progression For T1 Bladder Cancer

You have accessJournal of UrologyBladder Cancer: Superficial I1 Apr 20121676 DELAYED CYSTECTOMY INCREASES THE RISK OF SYSTEMIC PROGRESSION FOR T1 BLADDER CANCER Eric Umbreit, Mark Shimko, Torrence Wilson, R. Houston Thompson, and Igor Frank Eric UmbreitEric Umbreit Rochester, MN More articles by this author , Mark ShimkoMark Shimko Rochester, MN More articles by this author , Torrence WilsonTorrence Wilson Rochester, MN More articles by this author , R. Houston ThompsonR. Houston Thompson Rochester, MN More articles by this author , and Igor FrankIgor Frank Rochester, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1534AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES For patients with lamina propria invasive bladder cancers, immediate radical cystectomy may provide optional survival outcomes compared to initial bladder preservation strategies. This study aims to evaluate the oncologic outcomes of immediate cystectomy versus bladder preservation strategies in patients with properly staged T1 bladder cancer. METHODS 404 patients underwent transurethral resection (TUR) for T1 bladder cancer at our institution between 1995 and 2005. Patients were grouped: (1) immediate cystectomy (n=56) and (2) restaging TUR confirming T1 disease with subsequent bladder preservation (n=141). We evaluated systemic progression-free survival and cancer-specific survival for T1 bladder cancer managed by immediate cystectomy and bladder preservation strategies. Additionally, we compared immediate cystectomy to patients who progressed to a delayed cystectomy (n=37) following bladder preservation. RESULTS Immediate cystectomy (n=56) and bladder preservation (n=141) groups were well matched for age, sex, tobacco use, hydronephrosis, prior disease, grade, CIS and multifocality. Patients who underwent cystectomy were more likely to have multiple, synchronous T1 tumors (31% vs 17%,p=0.002) and had larger tumors on average (3 cm vs 2 cm, p=0.001). No significant differences in distant metastases-free survival, cancer-specific survival or overall survival were demonstrated between groups. Of bladder preservation patients, 37 of 141 (26%) patients progressed to cystectomy for muscle invasion (15 pts, 11%) or recurrent non-muscle invasive disease (22 pts, 15%). Predictive features of progression to cystectomy included history of BCG prior to T1 (HR 1.56, p=0.044), T1 on re-TUR (HR 2.01, p<0.001) and tumor size > 3cm (HR 2.76, p<0.001). Compared to immediate cystectomy, patients progressed from bladder preservation to cystectomy were significantly more likely to have non-organ confined disease (40% vs 25%, p=0.044) and develop distant metastases at five years (26% vs 12%, p=0.039). CONCLUSIONS Compared to immediate cystectomy, progression to delayed cystectomy for T1 bladder cancer treated with bladder preservation significantly increased the risk of non-organ confined disease and systemic progression. These results indicate that clinical T1 bladder cancer is frequently under staged and identifying factors associated with under staging and progression to cystectomy are critical to improving survival outcomes. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChang S (2015) Re: Improving Selection Criteria for Early Cystectomy in High-Grade T1 Bladder Cancer: A Meta-Analysis of 15,215 PatientsJournal of Urology, VOL. 194, NO. 5, (1230-1230), Online publication date: 1-Nov-2015. Volume 187Issue 4SApril 2012Page: e677 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Umbreit Rochester, MN More articles by this author Mark Shimko Rochester, MN More articles by this author Torrence Wilson Rochester, MN More articles by this author R. Houston Thompson Rochester, MN More articles by this author Igor Frank Rochester, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...