Management Of T1 Bladder Cancer Research Articles

MP22-20 CONTEMPORARY TRENDS IN THE MANAGEMENT OF T1 BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023MP22-20 CONTEMPORARY TRENDS IN THE MANAGEMENT OF T1 BLADDER CANCER Michael Hung, Adithya Balasubramanian, and Douglas Scherr Michael HungMichael Hung More articles by this author , Adithya BalasubramanianAdithya Balasubramanian More articles by this author , and Douglas ScherrDouglas Scherr More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003247.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The current treatment strategy for T1 non muscle invasive bladder cancer is centered around bladder preservation with an emphasis on complete tumor resection and BCG therapy. However, the insidious nature of T1 bladder cancer lead many to offer early radical cystectomy with or without additional systemic therapy. We sought to examine the contemporary treatment patterns in the management of T1 bladder cancer in a nationwide cohort. METHODS: The National Cancer Database (NCDB) was queried to identify all cases of cT1 bladder cancer from 2004 to 2017. Demographic and clinical characteristics were compared and trended over the study period. We identified subsequent surgical therapy after initial diagnosis and stratified patients who underwent radical cystectomy and those who underwent bladder preserving surgery alone. Kaplan Meier curves were used to estimate survival in these cohorts, stratified by the treatment facility. RESULTS: The total of 128,400 patients were identified in the study period. The rate of radical cystectomy in patients with T1 bladder cancer increased from 4.6% in 2004 to 7.5% in 2017 (Figure 1a). In patients who underwent radical cystectomy, the overall rate of neoadjuvant and adjuvant chemotherapy was 11% and 17%, respectively. There was no significant difference in median OS among patients who received neoadjuvant chemotherapy compared to no systemic therapy (8.6 yrs vs 7.5 yrs, p=0.15), and no difference in rates of pathologic upgrade to T2-4 at cystectomy (36.7% vs 34.6%, p=0.42). Patients who underwent cystectomy had significantly longer median OS compared to those who had bladder preserving surgery alone (7.5 yrs vs 7 yrs, p=0.01). A majority (58%) of all radical cystectomies were performed at academic facilities and median OS was significantly higher at academic facilities versus community hospitals (8.1 yrs vs 6.1 yrs, p<0.01) (Figure 1b). CONCLUSIONS: Rates of radical cystectomy for the management of T1 bladder cancer have increased over time, congruent with evidence suggesting improved survival compared to local therapy alone. However, increased rates of neoadjuvant chemotherapy were observed despite the lack of clear guidelines or benefits for use. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e305 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Hung More articles by this author Adithya Balasubramanian More articles by this author Douglas Scherr More articles by this author Expand All Advertisement PDF downloadLoading ...

Improving the management of T1 bladder cancer

Improving the management of T1 bladder cancer

A New and Highly Prognostic System to Discern T1 Bladder Cancer Substage

Background Management of T1 bladder cancer (BCa) is controversial. Objective Evaluate the impact of substage on the clinical outcome of T1 BCa. Design, setting, and participants The T1 diagnosis of 134 first-diagnosis BCa patients from two university hospitals was confirmed. For the T1 substage, we used a new system that discerns T1-microinvasive (T1m) and T1-extensive-invasive (T1e) tumors. We then determined the invasion of the muscularis mucosae–vascular plexus (MM-VP): T1a (invasion above the MM-VP), T1b (invasion in the MM-VP), or T1c (invasion beyond the MM-VP). If the MM-VP was not present at the invasion front, the case was assigned to T1a or T1c. All patients were initially managed conservatively (with bacillus Calmette-Guérin). Measurements Multivariable analyses for progression and disease-specific survival (DSS). Results and limitations Median follow-up was 6.4 yr (interquartile range: 3.3–9.2 yr). Progression to ≥T2 was observed in 40 patients (30%), and 19 patients (14%) died of BCa. The MM-VP was not present at the invasion front in 50 patients (37%). T1 substage was as follows: 40 T1m and 94 T1e; 81 T1a, 18 T1b, and 35 T1c. In multivariable analyses, substage (T1m/T1e) was significant for progression ( p = 0.001) and DSS ( p = 0.032), whereas substage according to T1a/T1b/T1c was not significant. Female gender ( p = 0.006) and carcinoma in situ ( p = 0.034) were also significant predictors of progression. The main limitation to the study is absence of a repeat transurethral resection. Conclusions Substage according to the new system (T1m and T1e) was user-friendly, possible in 100% of cases, and very predictive of T1 BCa behavior. Future studies may ultimately lead to the incorporation of this new substaging system in the TNM classification system for urinary BCa.