Stenzl - Figure 16
High Risk NMIBC
FIG. 16: A number of problems can arise with T1 tumors, one of which is understaging the tumor. When the pathology report identifies a T1 tumor, understaging may be present; muscle-invasive disease may be present in up to 25% of all tumors, or the tumor may be persistent despite an initially extensive TURB in 33-55% of the patients.[8,9]
We have clinically applied some of the risk factors to patients and analyzed whether there is a single T1 or multiple T1 tumors, and whether carcinoma in situ appears along with it or not – and this really changes the outcome. There is a 30% risk of concurrent carcinoma in situ and up to 37% risk of multiple tumors,[8.10] but these are still not the only risk factors that will lead to an unfavorable outcome.
Solitary tumors represent only the tip of the iceberg, with apparently no carcinoma in situ; nevertheless these patients may already harbor lymphangials, a lymphangitis carcinomatosa, or lymph node involvement that will eventually kill the patient if it is not identified early enough so we can apply every possible form of treatment that is now available.
References
Duchek M, Johansson R, Jahnson S, et al; Members of the Urothelial Cancer Group of the Nordic Association of Urology. Bacillus Calmette-Guérin is superior to a combination of epirubicin and interferon-alpha2b in the intravesical treatment of patients with stage T1 urinary bladder cancer. A prospective, randomized, Nordic study. Eur Urol. 2010;57:25−31 https://doi.org/10.1016/j.eururo.2009.09.038
Babjuk M, Böhle A, Burger M, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: Update 2016. Eur Urol. 2017;71:447−61 http://dx.doi.org/10.1016/j.eururo.2016.05.041
Dalbagni G, Vora K, Kaag M, Cronin A, et al. Clinical outcome in a contemporary series of restaged patients with clinical T1 bladder cancer. Eur Urol. 2009;56:903−10 https://doi.org/10.1016/j.eururo.2009.07.005
