Shariat - Figure 39
Risk assessment in T1 (56 studies, n = 15,215)
FIG. 39: Risk assessment of T1 bladder cancer is essential to determine the appropriate therapy at the proper time in the responsive patient. This Figure highlights the results from a meta-analysis of 15,215 patients, showing that at 5 years, recurrence rate was 42%, progression rate 21%, and mortality was between 10% and 20%.[52]
Many risk factors have been identified, as discussed previously, one of which is concomitant CIS, which confers a worse prognosis and a high likelihood of failing BCG intravesical therapy, and therefore progression and eventual mortality in a subgroup of patients. CIS in the prostatic urethra, as previously discussed, portends a worse prognosis, as these patients often do not respond to BCG therapy.
Two other risk factors that it is essential investigate, as they will significantly affect the outcome of the patient, are the presence of lymphvascular invasion or an aggressive variant histology. Other factors often confer a worse prognosis but are not strong enough alone to alter the therapeutic modality, although if ≥1 of them are present this will have an effect and should promote consideration of early cystectomy. These factors are: pattern of tumor invasion, tumor size, growth pattern, multifocality, and location of the tumor and whether it is completely resectable.
References
Martin-Doyle W, Leow JJ, Orsola A, et al. Improving selection criteria for early cystectomy in high-grade t1 bladder cancer: a meta-analysis of 15,215 patients. J Clin Oncol. 2015;33:643−50 http://doi.org/10.1200/JCO.2014.57.6967
