Pathological T3a & B Bladder Cancer Prognosis: Primarily Invasive & Initially Superficial But Subsequent Progressive Invasive Disease, No Difference

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 21 Jun 2008 - 6:00 PDT

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ORLANDO, FL (UroToday.com) - A Swiss group sought to determine if a prognostic difference exists between primary and initially superficial but subsequently progressive invasive pathological pT3a and b transitional cell carcinoma (TCC) of the bladder.

From 1987 to 2005, a consecutive series of 900 patients underwent radical cystectomy (RC) and extended bilateral pelvic lymphadenectomy at their institution for TCC of the bladder. Of these, 900 patients, 109 (20 women, 89 men) were found to have pathological pT3a and b after undergoing surgery either for primary invasive disease (n=54) or initially superficial, but subsequently progressive invasive disease (n=55). Prior to cystectomy, management of the initially superficial, but subsequently progressive disease patients was conducted at outside institutions. Baseline data including patient and tumor characteristics were collected at the time of the invasive tumors diagnosis. The duration of survival was defined as time form RC to disease-specific death. The 2-sample tests were used to compare the cumulative incidence of death due to TCC between primary and progressive patients.

Median age at time of RC was 66 years (range: 46-87). Of the 55 patients with initially superficial, but subsequent progressive invasive disease, 2 TURBTs were performed on 15 patients, 3 on 23 patients, 4 on 9 patients, 5 on 3 patients, 6 on 2 patients, 7 on 2 patients and 9 on 1 patient. Of these 55 patients, 14 received intravesical BCG, 5 for carcinoma in situ and 9 for T1G3 disease. One patient had half a course of BCG, 10 patients 1 course, 1 patient 2 courses, and 2 patients had 3 courses. Of the 109 patients, 38 were found to have positive nodes on histologic examination. There was no evidence of a statistically significant difference in the cumulative incidence of death due to TCC between primarily and subsequently progressive cystectomized patients (p-value = 0.60).

They conclude that the pathological extent of tumor invasion at the time of RC and not the clinical history seems to determine the outcome of patients with TCC growth outside the bladder. Therefore, patients with initial superficial disease should not be allowed to progress, as the outcome for patients with perivesical invasive bladder cancer is poor.

Presented by Nivedita Dhar, MD, George N Thalmann, MD, Pascal Zehnder, MD, Karsten Reinhardt, MD, Urs E Studer, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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