High-grade superficial bladder tumors (PT1G3): Prognostic factors of recidive and progression

Abstract

PT1G3 High-grade bladder tumors are superficial, poorly differentiated, they are characterized by there architectural disorganization and marked cytologic abnormalities. These tumors pose a diagnostic problem for the pathologist and a therapeutic problem for the urologist. The aim of this work is to study the predictive factors for recurrence and progression of pT1G3 bladder tumors. Material and method We undertook in this work a retrospective descriptive study, including 100 patients who were treated in the urology department between January 2010 and December 2012 at the University Hospital of Rabat (Morocco) for urothelial carcinoma classified T1G3. Rates of recurrence, progression were studied, and specific survival was done by the Kaplan–Meier method. The prognostic factors associated with this type of tumor were then investigated by Cox regression. The overall mean decline in the study was 53.7 months about 4.5 years. The patients were 91 (91%) men and 9 (9%) women. The average age of our patients was 58 years old with extremes ranging from 25 to 71 years old. Of the 100 patients in the study, 66 (66%) were classified T1G3 from the outset, while 34 were classified T1G3 during a recurrence (T1G3 secondary). Initial treatment consisted of deep and complete transurethral resection (RTU) in all patients. Follow-up of a BCG protocol therapy in 56 patients, among 56 (56%) patients who received BCG therapy 15 (26%) recidivated including 5 in progression, for another 44 (44%) patient group 30 (68%) recidivated, 12 of which were under progression. In univariate analysis, the significantly identified risk factors for recurrence were: tumor size > 5 cm (P = 0.01), multifocality of lesions and the lack of the adjuvant treatment to the transurethral resection of the bladder (P = 0.001) including BCG therapy. In multi-varied analysis, the significantly identified risk factors for progression and recurrence were: the presence of carcinoma in situ and the failure of BCG therapy (P = 0.001). The primary or secondary character of the tumor was not significant (P = 0.4). Thus, the difference in overall survival as a function of the initial or secondary status of T1G3 tumors was not significant when the other prognostic factors were taken into consideration. The results of this retrospective study suggest that T1G3 tumors can be safely controlled by the RTU + BCG combination. These results justify a good deep resection followed by a second resection at 6-week intervals and intravesical BCG instillations. This study also identifies PT1G3 patients at high-risk of recurrence and progression and requires close monitoring.