Tumor progression and survival in patients with T1G3 bladder tumors: multicentric retrospective study comparing 94 patients treated during 17 years

• Published in: Urology (Ridgewood, N.J.) N.J.), 2001-10, Vol.58 (4), p.551-556
• Main Authors: Patard, Jean-Jacques, Moudouni, Said, Saint, Fabien, Rioux-Leclercq, Nathalie, Manunta, Andrea, Guy, Laurent, Ballanger, Philippe, Lanson, Yves, Hajri, Mocktar, Irani, Jacques, Guillé, François, Beurton, Daniel, Lobel, Bernard
• Format: Article
• Language: English
• Subjects: Aged; BCG Vaccine; Biological and medical sciences; Combined Modality Therapy; Cystectomy; Disease Progression; Disease-Free Survival; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; Neoplasms, Multiple Primary - mortality; Neoplasms, Multiple Primary - pathology; Neoplasms, Multiple Primary - therapy; Nephrology. Urinary tract diseases; Retrospective Studies; Survival Rate; Tumors of the urinary system; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - therapy; Urinary tract. Prostate gland
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(01)01324-3

Objectives. To compare tumor recurrence, progression, and patient survival in T1G3 bladder tumors treated with transurethral resection (TUR) alone, early cystectomy, or TUR with an adjuvant 6-week course of bacille Calmette-Guérin (BCG) and followed up for a minimum of 5 years. Methods. Between 1979 and 1996, 94 patients with T1G3 bladder tumors (lamina propria invasion) were treated at nine different centers. The time to tumor recurrence, tumor stage and grade progression, number of delayed cystectomies, and patient survival were analyzed retrospectively in relation to the initial treatment. Results. The mean follow-up was 62 months. Thirty patients were treated by TUR alone (32%), 50 patients by TUR plus BCG (53%), and 14 patients by primary cystectomy (15%). The recurrence, progression, and cystectomy rates were significantly different between patients treated by TUR alone and TUR plus BCG (Fisher’s exact test, P = 0.0005, P = 0.02, and P = 0.005, respectively). The disease-free survival was also significantly different when comparing TUR plus BCG with TUR alone or primary cystectomy (Kaplan-Meier analysis, log-rank test, P = 0.02). Conclusions. Endoscopic resection plus BCG treatment of pT1G3 tumors allows an 80% rate of disease-free 5-year survival with bladder preservation. This conservative option has been widely accepted as first-line treatment, offering good cancer control with excellent quality of life. Very accurate surgical and pathologic evaluations before treatment and lifelong follow-up are obviously required.