Transitional Cell Carcinoma Of The Bladder Research Articles

Transitional cell carcinoma of the bladder in first decade of life

This report describes two rare cases of well-differentiated, non-invasive transitional cell carcinomas in children (Grade 1 Stage pTa). One was 8-year-old girl with a polypoid lesion and the other 9-year-old girl with kissing bilateral paraureteral lesions. The initial presentation was haematuria and symptoms of urinary tract infection. Subsequent course and investigation confirmed the diagnosis. Complete resection of the lesion and follow-up with urine cytology, vesical ultrasound and check cystoscopy at 4 years has showed no evidence of recurrence.

Review Articles: Pathogenesis and Diagnostic Significance of Nuclear Grooves in Thyroid and Other Sites

Nuclear grooves are longitudinal invaginations of the nuclear envelope bilayer, which constitute a characteristic feature of papillary thyroid carcinoma. Their pathogenesis is not yet clear, but there is evidence for the involvement of a signaling pathway downstream of the protooncogene RET. The presence of nuclear grooves is not specific for papillary thyroid carcinoma because it has been documented in other types of thyroid neoplasms, in nonneoplastic thyroid lesions, in ovarian neoplasms (Brenner, adult granulosa cell, and transitional cell tumors), in breast carcinomas, in cervicovaginal and endometrial smears, in papillary neoplasms of several organs (such as papillary transitional cell carcinoma of the bladder, papillary renal cell carcinoma, papillary endometrioid carcinoma of the prostate), in thymic carcinomas, and in nonepithelial tumors.

The presence of lymphovascular invasion in radical cystectomy specimens from patients with urothelial carcinoma portends a poor clinical prognosis

To assess the prognostic significance of lymphovascular invasion (LVI) on clinical outcomes in patients with transitional cell carcinoma of the bladder treated with radical cystectomy (RC). We retrospectively evaluated a prospectively maintained and authorised cystectomy database; the presence or absence of LVI was determined by pathological examination of the RC specimen. Cox regression analysis and Kaplan-Meier tables were developed to evaluate the contribution of LVI to clinical outcomes. In all, we analysed 356 patients treated with RC and urinary diversion between 1988 and 2006, with a mean follow-up of 45.6 months. Of these patients, 242 (68%) had no evidence of LVI in the RC specimen, whereas 114 (32%) had LVI. Patients with LVI tended to present with higher pathological stage; 84 (74%) had pT3 or pT4 disease. On univariable analysis the presence of LVI conferred a significant risk for decreased overall, cancer-specific and recurrence-free survival (P < 0.001); the mean values for LVI-negative patients were 96.8, 157.4, and 135.0 months, respectively, vs LVI-positive patients, whose survival times were 52.3, 82.7 and 75.2 months, respectively. The multivariable analysis showed significant independent risk for cancer-specific and overall survival for patients who were LVI-positive and had no lymph-node metastases. The hazard ratios (95% confidence interval) were 1.63 (1.06-2.51, P < 0.026) and 1.81 (1.06-3.08, P < 0.03) for overall and disease-specific survival, respectively. The presence of LVI in the pathological RC specimen confers significant independent risk for reduced bladder cancer-specific and overall survival. This variable could be used to prospectively stratify patients who would benefit from adjuvant chemotherapy.

Alpha-fetoprotein-producing transitional cell carcinoma of the urinary bladder: a case report

We report a 76-year-old man with alpha-fetoprotein (AFP)-producing transitional cell carcinoma of the bladder. Although the serum level of AFP was 1,428 ng/ml, and he was anti-hepatitis C virus (anti-HCV) antibody-positive, liver tumors were not detected by either a computed tomography (CT) scan or a hepatic angiography. However, removal of a bladder tumor by transurethral resection and subsequent pathological examination revealed a grade III transitional cell carcinoma (TCC). Furthermore, immunohistochemical detection of AFP was diffuse-positive. After the tumor partially responded to concomitant chemoradiotherapy, the serum AFP levels decreased to 966 ng/ml. However, the tumor eventually progressed with multiple lung metastases, and serum AFP levels increased to 3,906 ng/ml. In conclusion, AFP-producing TCC of urinary bladder is rare, and the nature and pathophysiology remains unclear and warrants further investigation.

Follow-up of nonmuscle invasive transitional cell carcinoma of the bladder: how and how often?

Nonmuscle invasive bladder cancer represents a heterogeneous disease due to different natural history of its various appearances. The purpose of this article is to review recent literature regarding follow-up strategies. Management of nonmuscle invasive bladder cancer has become more complex in respect to diagnosis, treatment and follow-up. Follow-up should therefore be based on individual patient-risk assessment. In addition to improved diagnosis by fluorescence-guided cystoscopy and other new diagnostic tools like optical-coherence tomography management has concentrated on optimizing different concepts of intravesical therapy. The intent of nonmuscle invasive bladder cancer management is to control recurrence and progression and to identify invasive tumours at the earliest possible stage. To obtain exact staging, besides a proper transurethral resection of bladder, a restaging transurethral resection of bladder should be performed in T1 patients. Data from the literature supports the immediate postoperative intravesical instillation of different chemotherapeutic agents in low-risk patients. Multifocal papillary lesions might necessitate a more intensive adjuvant regimen, whereas intravesical immunotherapy using bacillus Calmette-Guerin is recommended in patients who are at a high-risk of progression. Early cystectomy should be considered in patients with recurrent T1 tumours or refractory carcinoma in situ to avoid unfavourable tumour progression.

An Analysis of the Effect of Statin Use on the Efficacy of Bacillus Calmette-Guerin Treatment for Transitional Cell Carcinoma of the Bladder

Bacillus Calmette-Guerin is an effective immunotherapy for carcinoma in situ of the bladder and it reduces recurrence from resected papillary transitional cell carcinoma of the bladder. Many patients receiving bacillus Calmette-Guerin therapy are concurrently taking statin agents, which have known immunomodulatory properties and may alter the performance of bacillus Calmette-Guerin. Some data have suggested that patients taking a statin while on bacillus Calmette-Guerin therapy experience reduced clinical efficacy. We conducted a retrospective review of 952 consecutive patients from 1978 through 2006. Time to recurrence and progression to surgery were compared between those taking and those not taking a statin by Kaplan-Meier methods and multivariable Cox regression controlling for stage and grade. There were 245 (26%) patients taking a statin before bacillus Calmette-Guerin therapy and 707 not on statin therapy (74%). A total of 796 patients had recurrence overall with 214 in the statin group and 582 in the other group. Median time to recurrence was similar between those who did and those who did not use a statin. On multivariable analysis statin use was not significantly associated with recurrence (hazard ratio 1.04; 95% CI 0.81, 1.34; p = 0.7) or progression to surgery (hazard ratio 0.77; 95% CI 0.52, 1.13; p = 0.17) after bacillus Calmette-Guerin therapy. This retrospective study in a large cohort of patients showed no statistically significant association between statin use and recurrence or progression to open surgery in patients treated with bacillus Calmette-Guerin for transitional cell carcinoma of the bladder. Based on these data patients should not be discouraged from taking statins while undergoing bacillus Calmette-Guerin treatment.

Preoperative hydronephrosis as an indicator of survival after radical cystectomy

Objective We determined the prognostic significance of preoperative hydronephrosis in patients with transitional cell carcinoma (TCC) of the bladder undergoing radical cystectomy. Materials and Methods We performed a retrospective review of all patients undergoing radical cystectomy at a single institution from 1996 to 2006. Exclusion criteria included diagnosis other than TCC, upper tract TCC, incomplete medical records, or obstructing stones. Hydronephrosis was confirmed by radiographic imaging. Survival was determined by date of death or last clinic visit. Results Three hundred eight patients fulfilled the inclusion criteria; 203 (66%) had normal upper tracts, 82 (27%) had unilateral hydronephrosis, and 23 (7%) had bilateral hydronephrosis. Median overall survival of the study population was 34.3 months. There was a statistically significant difference in median survival between those without hydronephrosis (46.3 months), and those with unilateral (18.6 months, P = 0.004) or bilateral (13.4 months, P < 0.001) hydronephrosis. Preoperative hydronephrosis was significantly associated with higher pT stage ( P < 0.001) as well postoperative positive margins ( P = 0.039), but not with positive lymph nodes ( P = 0.086). Preoperative hydronephrosis had no significant effect on survival in patients with pT0-3a, N0, surgical margin negative tumors, but was significantly correlated with decreased survival in patients with pT3b or greater, or N+, or surgical margin positive tumors (median survival 12.8 months vs. 23.4 months, P = 0.011). On multivariate analysis, preoperative hydronephrosis was a significant predictor of decreased survival. Conclusions Preoperative hydronephrosis is an important and independent prognostic variable in patients with TCC of the bladder treated with radical cystectomy.

HLA‐G polymorphism and transitional cell carcinoma of the bladder in a Brazilian population

The morphologic appearance and clinical behavior of the human urinary bladder papillary transitional cell carcinoma (TCC) probably result from a complex interaction between carcinogenic insults and host resistance during the patient's life. While the main recognized risk factors are of environmental origin (e.g. smoking), relatively little information exists about the susceptibility to TCC development. The human leukocyte antigen G (HLA-G) molecule plays an important role in immune response regulation and has been implicated in the inhibition of the cytolytic function of natural killer and cytotoxic T cells. Several lines of evidence indicate that HLA-G polymorphisms influence the expression level and production of different HLA-G isoforms. The aim of this study was to explore a possible influence of the HLA-G polymorphism on the susceptibility to urinary bladder TCC development and progression in smokers and nonsmokers Brazilian subjects. The HLA-G locus was found to be associated with susceptibility to TCC development and progression. The G*0104 allelic group (specially the G*010404 allele) and the G*0103 allele were associated with a tobacco-dependent influence on TCC development. The G*0104 group was associated with progression to high-grade tumors, irrespective of smoking habit, while the G*0103 allele was associated to high-grade tumor only in smoking patients. Our results are an evidence that the HLA-G locus itself, or as part of an extended haplotype encompassing this chromosome region (particularly the HLA-A given the high linkage disequilibrium observed between them in this data series), may be associated with TCC susceptibility and tumor progression, suggesting a tobacco-dependent influence of these polymorphisms.

Neoadjuvant chemotherapy preceding cystectomy for bladder cancer

Background: Occult micrometastasis at the time of radical cystectomy leads predominantly to distant failures in patients with locally advanced, muscle-invasive transitional cell carcinoma of the bladder. Objectives: Data supporting neoadjuvant chemotherapy for locally advanced bladder cancer are reviewed. Results: Studies evaluating adjuvant chemotherapy have been limited by inadequate statistical power. However, randomized clinical trials have demonstrated a survival benefit for neoadjvuant cisplatin-based combination chemotherapy. Trials employing neoadjuvant therapy are particularly valuable in the development of novel systemic therapy regimens, since pathological complete remission appears to be a powerful prognostic factor for long-term survival. Conclusion: Neoadjuvant chemotherapy is a standard for the therapy of locally advanced bladder cancer, and the neoadjuvant paradigm may assist in accelerating novel agent development.

Clinical implications of the MDM2 SNP309 and p53 Arg72Pro polymorphisms in transitional cell carcinoma of the bladder

Recent studies have shown that functional polymorphisms at the MDM2 SNP309 T/G and p53 Arg72Pro may be associated with cancer susceptibility. However, the role of these polymorphisms on the risk of transitional cell carcinoma of the bladder (TCCB) and clinical outcome remains unknown. SNP309 and p53 Arg72Pro polymorphisms were genotyped in 227 patients and 266 control subjects. The association between each polymorphism, TCCB risk and clinical outcome was evaluated by using a logistic regression model, a Kaplan-Meier curve with the log-rank test, or a Cox proportional hazard model. No significant associations between the polymorphisms and TCCB risk were found. On the MDM2 SNP309, the TT patients with superficial TCCB tended to have a longer recurrence-free survival than the TG or GG patients after transurethral resection (P=0.074). On the p53 Arg72Pro, the Pro/Pro patients with superficial TCCB had a significantly lower risk for recurrence than the Arg/Pro or Arg/Arg patients [Hazard ratio (HR), 0.364; 95% confidence interval (CI), 0.14-0.93]. In contrast, the Pro/Pro patients following radical cystectomy showed a significantly poorer survival and a higher risk of disease-specific death than the Arg/Pro + Arg/Arg patients (HR, 2.76; 95% CI, 1.11-6.84). MDM2 SNP309 and p53 Arg72Pro polymorphisms might influence the clinical outcome of TCCB in a distinctive way between superficial TCCB and invasive TCCB. The results may reflect marked differences in the genetic background between superficial and an invasive type of TCCB.

Dietary patterns and risk of bladder cancer: a factor analysis in Uruguay

To determine the major dietary patterns associated with bladder cancer risk, we conducted a principal components analysis (PCA) in a case-control study from Uruguay. A total of 255 newly diagnosed and microscopically confirmed cases of transitional cell carcinoma of the bladder and 501 hospitalized controls were included in the study. Both series were drawn from the four major public hospitals in Montevideo, Uruguay. Cases and controls were frequency matched on age and sex. Controls were submitted to factor (principal components) analysis. We retained three factors that explained 25.1% of the total variance (including error variance). The first factor was labeled as the sweet beverages pattern. This factor was characterized by high loadings of coffee, tea, and added sugar and was strongly associated with risk of bladder cancer (OR 3.27, 95% CI 1.96-5.45). The second factor was labeled as the Western pattern and displayed high loadings of red meat, fried eggs, potatoes, and red wine. This pattern was directly associated with risk of bladder cancer (OR 2.35, 95% CI 1.42-3.89). Finally, the third factor was labeled as the prudent pattern and showed high loadings of fresh vegetables, cooked vegetables, and fruits. This pattern was not associated with risk of bladder cancer. According to our study, non-alcoholic beverages were the strongest risk factor for bladder cancer, whereas the Western pattern was also associated with a significant increase in risk of bladder cancer.

Expression of Vascular Endothelial Growth Factor, Receptor KDR and p53 Protein in Transitional Cell Carcinoma of the Bladder

Aim: To evaluate the expression profile of vascular endothelial growth factor (VEGF), kinase-insert-domain-containing receptor (KDR) and p53 in patients from Northeastern China with transitional cell carcinoma (TCC) of bladder. Materials and Methods: One hundred and twelve patients with bladder transitional cell carcinoma were involved in this study. The expression of VEGF, KDR and p53 were evaluated by immunohistochemical staining on paraffin-embedded slides. The correlations between the biomarkers with clinical pathological characteristics were assessed; the co-expression of VEGF and KDR in tumor cells as well as the correlation between p53 and VEGF/KDR expression were analyzed. Results: Expression of VEGF, KDR and p53 was observed in 69.6, 55.4 and 48.2% of TCC patients, respectively. VEGF, KDR and p53 expressions were found to be higher in the invasive bladder tumors than in the superficial tumors, and KDR and p53 expression were significantly associated with higher tumor grade. Co-expression of VEGF and KDR was found in 51 patients, and VEGF expression was associated with KDR expression. Positive correlations were found between p53 protein and VEGF/KDR expression. Conclusion: Our results suggest that VEGF, KDR and p53 might be valuable biomarkers in prognosis of TCC patients. Co-expression of VEGF and KDR implied an autocrine signaling of VEGF in tumor cells, and the results of immunohistochemical staining supported the role of p53 gene in the process of angiogenesis.

Incorporating fluorescence cystoscopy for the diagnosis of bladder cancer into clinical practice

In this Viewpoint article by Dr Karl and colleagues, the authors discuss the benefits of fluorescence cystoscopy for the diagnosis of transitional cell carcinoma of the bladder, which include reduced residual tumor rate and tumor recurrence rate, and enhanced detection of carcinomain situand multifocal tumors, when compared with white-light cystoscopy.

Multimodale Therapien zum Blasenerhalt bei High-grade-Blasentumoren

The demographic changes of our society, with an increasing number of elderly patients and higher comorbidity, leads to the fact that managing transitional cell carcinoma (TCC) in the elderly is becoming increasingly more important. Thus, the value and indication of conservative or less invasive treatment approaches have to be continuously re-evaluated. The gold standard of treatment for invasive high grade TCC is radical cystectomy with curative intent. However, not each and every patient is suitable for this procedure or the operation is rejected. Thus, alternative treatment options (curative or palliative) including bladder sparing approaches should be offered to this group of patients. These include transurethral resection (TUR-B), open partial cystectomy, chemotherapy (intravesical or systemic), local radiation and minimally invasive interventional therapies alone or in combination. A lower physical and mental burden and, more important, a faster convalescence and the maintenance of the quality of life, are the major aims of these strategies. From an oncologic point of view these concepts have to be viewed with caution, since they may only lead to a temporarily stable disease or the elimination of symptoms. However, long-term follow-up demonstrates that with the correct indication for a multi-modal treatment, a subset of patients with high grade TCC of the bladder may be cured when implementing a bladder sparing approach.

Clinical use of serum CA-125 levels in patients undergoing radical cystectomy for transitional cell carcinoma of the bladder

Purpose It has recently been reported that serum CA-125 levels may serve as a prognostic indicator of extravesical disease in patients with bladder cancer. This study evaluated the role of CA-125 as a prognostic marker in patients with transitional cell carcinoma of the bladder undergoing radical cystectomy and urinary diversion. Methods Ninety-two consecutive patients underwent planned radical cystectomy and urinary diversion with curative intent (2005–2006). Serum CA-125 levels were obtained in all patients and correlations were made to clinical and operative findings and pathological outcomes. Outcomes were evaluated with regard to normal vs. abnormal CA-125 values and with regard to absolute values of CA-125 levels. Results were also stratified by short-term recurrence rates. Results Mean CA-125 values varied significantly by pathological stage and by resectability. No patient (0/56) with organ-confined disease (≤pT2N0) had an abnormal CA-125, and only 1 patient (1/75 = 1.3%) with ≤pT3N0 disease had an abnormal value. Conversely, 35% of patients with regionally-advanced disease (pT4 or N+) had an elevated CA-125, and all patients with unresectable disease (5/5) had an elevated value. In addition, patients with abnormal values of CA-125 (i.e., <35 U/ml) had a significantly higher upstaging rate compared to non-upstaged patients (18.8% vs. 3.5%, respectively; P = 0.0233). As well, patients with CA-125 levels <15 U/ml had a significantly higher upstaging rate compared with non-upstaged patients (53.1% vs. 15.8%, respectively; P = 0.0005). At a mean follow-up of 15 months (median = 14 months), patients with T2/T3N0 disease who recurred had a higher mean value than patients with pT2/T3 disease who did not recur (20.1 vs. 10.8 U/ml). Conclusions Serum CA-125 levels may serve as a useful predictor of pathological outcomes in patients undergoing cystectomy for urothelial carcinoma of the bladder. Further studies will be carried out to determine the predictability of CA-125 on long-term recurrence and survival rates, and to evaluate the utility of CA-125 as a marker for disease response in patients with recurrent or advanced disease undergoing systemic therapy.

Clinical Results of a Concomitant Boost Radiotherapy Technique for Muscle-Invasive Bladder Cancer

To update the results of external radiotherapy with a focal concomitant boost technique on local control and bladder function in patients with muscle-invasive bladder cancer. The authors retrospectively evaluated 92 elderly or disabled patients with localized T2-4 N0-1 M0 transitional cell carcinoma of the bladder and a median age of 79 years, not suitable for radical surgery and treated between 1994 and 2005. Treatment consisted of a dose of 40 Gy/2 Gy to the small pelvis with a daily concomitant boost of 0.75 Gy to the tumor. Total dose was 55 Gy in 4 weeks. Complete remission rate after evaluation by means of cystoscopy at 3 months was 78%. 3-year local control rate amounted to 56%, and 3-year overall survival to 36%. The posttreatment bladder capacity was comparable with the pretreatment capacity and was > or = 200 ml in 81% of the cases. Mean bladder capacity did not deteriorate at longer follow-up. The local control rate after external beam radiotherapy in elderly patients with a focal concomitant boost for localized muscle-invasive bladder cancer was 56% at 3 years. Functional bladder outcome was good.

Robot-Assisted Laparoscopic Radical Cystoprostatectomy with Ileal Conduit Urinary Diversion: Initial Experience in Korea

In this paper, we report our initial experience of robot-assisted laparoscopic radical cystoprostatectomy (RLRC) with an ileal conduit urinary diversion (ICUD). Our patient was a 59-year-old man presenting with a clinical T4 invasive transitional cell carcinoma of the bladder and prostate. A RLRC was performed with the da Vinci() robot system (Intuitive Surgical, Mountain View, CA), which has a total of seven degrees of motion (six degrees of freedom and grip), and EndoWrist (Intuitive Surgical) instrumentation. The specimen was extracted through the 8-cm-sized incision in the umbilical trocar site. The ICUD was achieved through a removal site of a specimen by an extracorporeal technique. The total operative time was 340 minutes and the estimated blood loss was 600 mL. The pathologic examination showed a stage T4a, with negative surgical margins. A RLRC can be an alternative to the open technique. We are the first group to perform RLRC in Korea and to report on our technique and outcome.

Editorial Comment on: Large-scale Real-time Reverse Transcription-PCR Approach of Angiogenic Pathways in Human Transitional Cell Carcinoma of the Bladder: Identification of VEGFA as a Major Independent Prognostic Marker

Abstract Background Actors of the angiogenesis pathways are targets for the new promising targeted therapies already used in several malignancies. In bladder cancer, antiangiogenic molecules could also add to already existing treatment options. Objective To evaluate the involvement of angiogenesis pathways in bladder carcinogenesis and identify new molecular markers having a clinical implication. Design, setting, and participants Expression levels of 40 genes involved in angiogenesis were assessed by quantitative real time RT-PCR in 157 urothelial tumour bladder samples obtained from patients who underwent transurethral bladder resection or radical cystectomy between 2001 and 2005. Pathologic tumour staging showed: 73 non-muscle-invasive bladder tumours (30 low-grade pTa, 14 high-grade pTa, and 29 high-grade pT1), and 84 muscle-invasive tumours (≥ pT2), all of high grade. RT-PCR results were associated with a survival analysis. Results and limitations VEGFA , MET , CXCR4 , and IL8 were significantly overexpressed in tumour samples as compared to normal bladder tissue. VEGFA overexpressions were found in 89% of non-muscle-invasive and 66% of muscle-invasive tumour samples. In univariate analysis, for invasive tumours, VEGFA overexpression was associated with a poorer outcome in both overall and disease-free survival ( p =0.011 and 0.026 respectively) at a 13-mo median follow-up. Multivariate analysis retained T stage, N status, and VEGFA overexpression as independent prognostic factors in both overall and disease-free survival ( p =0.02 and p =0.04, respectively, for VEGFA ). Conclusions This study shows that, in bladder cancer, VEGFA status could be used as a prognostic factor at the individual level. VEGFA overexpression could guide a rationalized use of the costly antiangiogenic therapies which could therefore become part of the treatment options in bladder cancer.

Association of Low Expression of Notch-1 and Jagged-1 in Human Papillary Bladder Cancer and Shorter Survival

We investigated the expression of Notch receptors and ligands in normal bladder transitional epithelium and transitional cell carcinoma of the bladder. We also explored its clinical and pathological implications. The expression of Notch-1 to 3, Jagged-1 and Delta-like-1 was detected respectively in 70 cases of bladder carcinoma, 10 of normal urothelium and the 2 cell lines T24 and BIU-87 using immunohistochemistry. Reverse transcriptase-polymerase chain reaction and Western blot were used to assay the expression level of Notch-1 and Jagged-1. The predictive value of this expression for prognosis was investigated by Kaplan-Meier curves and Cox proportional hazards analysis in a multivariate model. All 5 kinds of Notch factors were intensively stained in normal bladder transitional epithelium immunohistochemically but expression was significantly decreased in tumor tissues. Moreover, expression of the 5 genes in papillary tumors was lower than in invasive tumors but only Notch-1 and Jagged-1 showed a statistically significant difference. Postoperative disease-free survival time in patients with low Notch-1 plus Jagged-1 expression was significantly shorter than that in patients with other expression patterns in papillary tumors (p = 0.014). Multivariate Cox proportional hazards model analysis identified Jagged-1 expression as an independent prognostic factor for disease-free survival (RR 3.09, p = 0.011). The Notch family expression pattern in papillary bladder transitional cell carcinoma is different from that in invasive bladder transitional cell carcinoma. Low expression of Notch-1 as well as Jagged-1 is potentially a useful marker for survival in patients with papillary bladder transitional cell carcinoma.

Access to care for stage 2 transitional cell carcinoma of the bladder

17568 Background: Receipt of aggressive therapy for invasive bladder cancer is influenced by clinical factors and patient sociodemographic characteristics. We assessed correlates of access to care for stage 2 transitional cell carcinoma (TCC) of the bladder where care algorithms are less equivocal and radical cystectomy (RC) remains the standard of care. We further stratified survival outcomes by treatment modality. Methods: SEER-Medicare subjects diagnosed with stage 2 TCC of the bladder from 1992–2000 were divided into 3 cohorts: those who underwent RC within 1 year, those who received chemotherapy or radiation therapy (Ch-XRT), and those who received no care (NC). We incorporated patient and provider characteristics into multivariate models comparing Ch-XRT and NC to RC. Multivariate Cox models compared survival stratified by treatment group adjusting for clinical determinants. Results: 21% of subjects with stage 2 TCC underwent RC; they were younger and had fewer comorbid conditions than Ch-XRT and NC subjects (p<0.001). Covariates associated with poor access to RC included age (OR 0.91, p<0.001), greater comorbidity (OR 0.32, p<0.001 for Charlson index ≥ 3 vs. Charlson 0), and cancer grade (OR 4.4, p<0.001 for grade 4 vs. grade 1). Use of RC did not vary by race, income, provider, or region. Subsetting a healthy cohort (age < 80 years, Charlson 0), death was associated with age (HR 1.03, p<0.001), being married (HR 0.68, p=0.007), cancer grade (HR 0.68, p=0.010 for grade 2 vs. 4), and treatment modality (HR 1.6, p<0.001 for Ch-XRT; HR 1.3, p=0.005 for NC vs. RC). Results were similar for the entire cohort (see Table). Conclusions: Few subjects with stage 2 TCC of the bladder undergo standard treatment. Although extirpative therapy appears to be determined by clinical parameters, we identified a large cohort of patients who would’ve benefited from more aggressive intervention. More detailed access models with incorporation of contextual variables may explain the differential care in these subjects. Cox model of mortality for SEER-Medicare subjects with stage 2 TCC of the bladder HR p-value Age (yrs) 1.05 <0.001 Female sex 1.40 <0.001 Ethnicity (vs. white) Black 1.17 0.30 Hispanic 1.00 0.99 Other 0.88 0.63 Married 0.82 0.14 Cancer grade (vs. 4) 2 9.68 0.005 3 1.08 0.43 Unknown 0.86 0.56 Region (vs. West) Northeast 1.03 0.80 Midwest 1.08 0.38 South 1.09 0.61 Treatment (vs. Ch-XRT) RC 1.17 0.45 NC 1.36 0.030 Interaction terms RC*Charlson 0 0.65 0.073 NC*Charlson 0 0.65 0.017 No significant financial relationships to disclose.