Early-stage bladder cancer surveillance does not improve survival if high-risk patients are permitted to progress to muscle invasion.

OBJECTIVES: Surveillance of early-stage bladder cancer (cTis-T1) permits bladder preservation with conservative treatments, using cystectomy to salvage patients with refractory disease. Despite close observation, some tumors progress to muscle invasion during this period. Historically, some believed that cystectomy applied in this setting could provide a better outcome in patients with "early" cT2 disease compared with those with de novo cT2 disease. We compared the pathologic and survival outcomes of patients with high-risk early-stage disease with those of patients with muscle-invasive tumors at presentation.
METHODS: A cohort of 422 consecutive patients underwent primary cystectomy for high-risk, progressive, or muscle-invasive bladder cancer. A retrospective review of the demographics, surveillance time, clinical and pathologic parameters, and survival was undertaken. The variables were tested in univariate and multivariate analyses.
RESULTS: Before cystectomy, 182 high-risk patients (44%) had cTis-T1 cancer at diagnosis but did not progress to cT2 disease (group 1); 69 patients (17%) had cTis-T1 that progressed to cT2 during surveillance (group 2); and 167 patients (40%) presented with cT2 tumors (group 3). Groups 2 and 3 had similar patterns of pathologic staging (P = 0.9862), disease-specific survival (P = 0.469), and overall survival (P = 0.643). The rate of understaging was similar in groups 2 and 3 (59% to 60%).
CONCLUSIONS: Patients with disease progression to cT2 bladder cancer during surveillance have similar patterns of pathologic staging and survival after cystectomy as those with de novo cT2 disease, likely because of the similar rates of tumor understaging.