Shariat - Figure 5
T1HG Bladder Cancer: AN AGGRESSIVE DISEASE
FIG. 5: T1 bladder cancer is an aggressive disease. Patients not treated with bacillus Calmette-Guérin (BCG) – up to 60%, based on data from pre-BCG era patients – experience disease progression to muscle-invasive disease. Today, in the BCG era, despite the best care administered to these patients, up to 30–40% of these patients will experience disease progression and eventual death from the cancer.[3,4]
Because T1 bladder cancer has early access to the lymphatic and vascular systems, approximately 18% of clinical cases are estimated to already have lymph node metastases. The most important reason for this is prior understaging.
From pathologically confirmed T1 (after radical cystectomy), approximately 7% of patients already have lymph node metastases, showing the early propensity of this disease to spread.[5] The major issue in dealing with T1 certainly comes from the difficulty in staging it appropriately. Somewhere between 30% to 60% of patients who are thought to be T1 end up to be a T2 cancer, ie, muscle-invasive on radical cystectomy.[7] The key question is how to identify the patients who will fail current conservative management and those who will actually not have a chance to respond at all, and to respond to them not with an early, but with an immediate radical cystectomy.
References
Nieder AM, Brausi M, Lamm D, et al. Management of stage T1 tumors of the bladder: International Consensus Panel. Urology. 2005;66(6 Suppl 1):108−25 http://dx.doi.org/10.1016/j.urology.2005.08.066
Cookson MS, Herr HW, Zhang ZF, et al. The treated natural history of high risk superficial bladder cancer: 15-year outcome. J Urol. 1997;158:62−7 http://dx.doi.org/10.1097/00005392-199707000-00017
Shariat SF et al. Eur Urol. 2008
Shariat SF et al. J Urol. 2006
Fritsche HM, Burger M, Svatek RS, et al. Characteristics and outcomes of patients with clinical T1 grade 3 urothelial carcinoma treated with radical cystectomy: results from an international cohort. Eur Urol. 2010;57:300−9 http://dx.doi.org/10.1016/j.juro.2010.01.025
