Shariat - Figure 48
Comparative Retrospective T1 High-grade Cancer Series
FIG. 48: Currently there are no high-quality comparison data of immediate radical cystectomy vs BCG. There are some retrospective series in patients with T1 high-grade cancer. One of these studies[65] compared 29 patients treated with immediate radical cystectomy with 92 patients who received transurethral resection with BCG. The mortality outcomes were identical, but 20–30% of the patients who were treated with radical cystectomy did not survive, thus showing that hematogenous spread had already occurred these patients, despite the fact that they had T1 grade tumors and 30% of the patients in the TURBT group eventually required radical cystectomy. They received it quite early, before progression to T2 disease, and therefore had a good outcome.
Another study[66] reported that patients who received an early cystectomy fared better than those who had a deferred cystectomy. The patient cohorts were approximately matched in size (54 vs 51 patients), and the 10-year cancer-specific survival of those with immediate radical cystectomy was 78% versus 51% in those with delayed radical cystectomy. All these patients not only had simple T1 high-grade cancers, but also ≥2 additional risk factors: carcinoma in situ, multifocal disease, or large tumor size (>3 cm). This shows that T1 bladder cancer should be treated with early, probably radical cystectomy. It should be considered in a significant number of these patients if multiple risk factors are present, but it is associated with the risk of overtreatment and morbidity from the surgery.
References
Thalmann GN, Markwalder R, Shahin O, et al. Primary T1G3 bladder cancer: organ preserving approach or immediate cystectomy? J Urol. 2004;172:70−5 https://doi.org/10.1097/01.ju.0000132129.87598.3b
Denzinger S, Fritsche HM, Otto W, et al. Early versus deferred cystectomy for initial high-risk pT1G3 urothelial carcinoma of the bladder: do risk factors define feasibility of bladder-sparing approach? Eur Urol. 2008;53:146−5 . http://dx.doi.org/10.1016/j.eururo.2007.06.030
