Role of immediate radical cystectomy in the treatment of patients with residual T1 bladder cancer on restaging transurethral resection
Correspondence: Guido Dalbagni, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
What's known on the subject? and What does the study add?
- Bladder cancer patients with lamina propria invasion (T1 disease) and residual T1 disease on restaging transurethral resection of bladder tumour (re-TURBT) are at a very high risk for recurrence and progression. Despite this risk, most patients are treated with a bladder preserving approach and not immediate radical cystectomy (RC).
- In this study we have shown that a quarter of patients with T1 bladder cancer and residual T1 on re-TURBT who are treated with immediate RC are found to have carcinoma invading bladder muscle at RC and 5% have lymph node metastases. We have also found that >30% of patients treated with deferred RC after initial bladder-preserving therapy harbour carcinoma invading bladder muscle and almost 20% of these patients have lymph node metastases. Thus, immediate RC should be considered in all patients with T1 bladder cancer and residual T1 on re-TURBT.
- To report the overall survival (OS) and cancer-specific survival (CSS) of patients with residual T1 bladder cancer on restaging transurethral resection of the bladder tumour (re-TURBT).
Materials and Methods
- We performed a retrospective review of 150 evaluable patients treated for T1 bladder cancer with residual T1 disease found on re-TURBT between 1990 and 2007.
- Patients were treated with immediate radical cystectomy (RC) or a bladder-preserving approach (deferred or no RC).
- A univariate Cox proportional hazards regression model was used to test the association between treatment approach and survival.
- Residual T1 bladder cancer was found in 150 evaluable patients, of whom 57 received immediate RC and 93 were treated with a bladder-preserving approach.
- Fourteen out of 57 patients receiving immediate RC and 8/26 patients receiving deferred RC had carcinoma invading bladder muscle in the RC specimen. Three out of 57 and 5/26 patients had lymph node metastases in the RC specimen.
- Median follow-up was 3.74 years.
- Thirty-nine patients died during follow-up, 16 from bladder cancer. There was no significant association between immediate RC and CSS (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.43–3.09, P = 0.8) or OS (HR 0.79, 95% CI 0.4–1.53, P = 0.5).
- Because of the low number of events we cannot conclude whether RC offers a survival advantage in patients with residual T1 bladder cancer on re-TURBT.
- Since a quarter of patients had carcinoma invading bladder muscle, RC should be considered in these patients.
- A larger, preferably randomized, study with longer follow-up is needed.