Abstract
ObjectivesTo compare the outcomes of bladder preservation therapy with early or deferred radical cystectomy (RC) in high-grade non-muscle invasive bladder cancer.MethodsProspectively collected data were obtained for patients undergoing transurethral resection of bladder tumor (TURBT) at a tertiary care center between 2007 and 2018. Patients with a high-grade tumor (HGT1) were divided into three groups, depending on the treatment plan: conservative (GI), early RC (GII), or deferred RC (GIII). Kaplan-Meier analysis was performed to assess the cancer-specific survival (CSS).ResultsSeventy-one patients were included, and the patients had a median (range) age of 49 (32-72) years. The GI, GII, and GIII groups included 34 (47.9%), 14 (19.7%), and 23 (32.4%) patients, respectively. A significantly lower number of GII patients underwent >2 TURBTs (14.3% vs. 100%, p<0.001). Compared to GIII patients, GII patients had a shorter time to RC from the initial diagnosis (5.7 vs. 36.2 months, p=0.03). Ileal conduit and orthotropic bladder diversions were comparable between both groups, with significantly higher postoperative complications in GIII patients. The median (IQR) follow-up times for the groups were 84 (49-102), 82 (52-112), and 73 (36-89) months, respectively. The five-year and 10-year CSS for GII and GIII patients was 79% vs. 75% and 78% vs. 64%, respectively (log rank=0.19).ConclusionEarly RC should be considered an alternative treatment option in selected patients with HGT1 BC with expected longer life expectancy, which may significantly decrease postoperative complications and improve the CSS. However, selection bias in the current retrospective study may influence these outcomes.
Highlights
Bladder cancer (BC) has high morbidity and mortality, with 549,393 new cases diagnosed worldwide in 2018 and 199,922 deaths [1,2]
Compared to GIII patients, GII patients had a shorter time to radical cystectomy (RC) from the initial diagnosis (5.7 vs. 36.2 months, p=0.03)
This aggressive behavior of high-grade T1 (HGT1) tumors significantly limits the effectiveness of bladder preservation strategies, including transurethral resection of the tumor (TURBT) followed by intravesical Bacillus Calmette-Guerin (BCG), which decreases the recurrence and progression rates [8]
Summary
Bladder cancer (BC) has high morbidity and mortality, with 549,393 new cases diagnosed worldwide in 2018 and 199,922 deaths [1,2]. Carcinoma in situ (CIS) and high-grade T1 (HGT1) cancer is an aggressive disease with a 23-74% tendency for recurrence and 50% progression to muscle-invasive disease, even after patients have received intravesical therapy [5,6,7]. Clinical understaging and persistence of the disease are common at initial transurethral resection, which necessitates a second-look resection for patients with HGT1. This aggressive behavior of HGT1 tumors significantly limits the effectiveness of bladder preservation strategies, including transurethral resection of the tumor (TURBT) followed by intravesical Bacillus Calmette-Guerin (BCG), which decreases the recurrence and progression rates [8]. Several studies have concluded that RC is the preferred treatment option due to better survival rates [10,11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
