PURPOSE: While many urologists recommend radical cystectomy for micropapillary bladder cancer invading the lamina propria (cT1), contradictory small reports exist on the efficacy of conservative management with intravesical bacillus Calmette-Guérin for this disease. We report our updated experience in what to our knowledge is the largest series of patients with cT1 micropapillary bladder cancer. MATERIALS AND METHODS: An institutional review board approved review of our cancer database identified 283 patients with micropapillary bladder cancer, including 72 staged with cT1N0M0 disease at diagnosis and initiation of therapy. Survival analysis was performed using the Kaplan-Meier estimator and compared using the log rank test. RESULTS: In this cohort of 72 patients 40 received primary intravesical bacillus Calmette-Guérin and 26 underwent up-front radical cystectomy. Of patients who received bacillus Calmette-Guérin 75%, 45% and 35% experienced disease recurrence, progression and lymph node metastasis, respectively. Patients treated with up-front cystectomy had improved survival compared to patients treated with primary bacillus Calmette-Guérin (5-year disease specific survival 100% vs 60% p = 0.006) and patients who underwent delayed cystectomy after recurrence (5-year disease specific survival 62%, p = 0.015). Prognosis was especially poor in patients who waited for progression before undergoing radical cystectomy with an estimated 5-year disease specific survival of only 24% and a median survival of 35 months. In patients treated with up-front cystectomy pathological up-staging was found in 27%, including 20% with lymph node metastasis. CONCLUSIONS: While certain patients with T1 micropapillary bladder cancer may respond to intravesical bacillus Calmette-Guérin, survival is improved in those who undergo early radical cystectomy. Further molecular studies are needed to identify subsets of patients in whom the bladder can be safely spared.
PURPOSE: While many urologists recommend radical cystectomy for micropapillary bladder cancer invading the lamina propria (cT1), contradictory small reports exist on the efficacy of conservative management with intravesical bacillus Calmette-Guérin for this disease. We report our updated experience in what to our knowledge is the largest series of patients with cT1micropapillary bladder cancer. MATERIALS AND METHODS: An institutional review board approved review of our cancer database identified 283 patients with micropapillary bladder cancer, including 72 staged with cT1N0M0 disease at diagnosis and initiation of therapy. Survival analysis was performed using the Kaplan-Meier estimator and compared using the log rank test. RESULTS: In this cohort of 72 patients 40 received primary intravesical bacillus Calmette-Guérin and 26 underwent up-front radical cystectomy. Of patients who received bacillus Calmette-Guérin 75%, 45% and 35% experienced disease recurrence, progression and lymph node metastasis, respectively. Patients treated with up-front cystectomy had improved survival compared to patients treated with primary bacillus Calmette-Guérin (5-year disease specific survival 100% vs 60% p = 0.006) and patients who underwent delayed cystectomy after recurrence (5-year disease specific survival 62%, p = 0.015). Prognosis was especially poor in patients who waited for progression before undergoing radical cystectomy with an estimated 5-year disease specific survival of only 24% and a median survival of 35 months. In patients treated with up-front cystectomy pathological up-staging was found in 27%, including 20% with lymph node metastasis. CONCLUSIONS: While certain patients with T1 micropapillary bladder cancer may respond to intravesical bacillus Calmette-Guérin, survival is improved in those who undergo early radical cystectomy. Further molecular studies are needed to identify subsets of patients in whom the bladder can be safely spared.
Authors: Massimiliano Spaliviero; Guido Dalbagni; Bernard H Bochner; Bing Ying Poon; Hongying Huang; Hikmat A Al-Ahmadie; Timothy F Donahue; Jennifer M Taylor; Joshua J Meeks; Daniel D Sjoberg; S Machele Donat; Victor E Reuter; Harry W Herr Journal: J Urol Date: 2014-03-03 Impact factor: 7.450
Authors: Adrian S Fairey; Siamak Daneshmand; Lina Wang; Anne Schuckman; Gary Lieskovsky; Hooman Djaladat; Jie Cai; Gus Miranda; Eila C Skinner Journal: Urol Oncol Date: 2013-03-14 Impact factor: 3.498
Authors: Daniel L Willis; Thomas W Flaig; Donna E Hansel; Matthew I Milowsky; Robert L Grubb; Hikmat A Al-Ahmadie; Elizabeth R Plimack; Theresa M Koppie; David J McConkey; Colin P Dinney; Vanessa A Hoffman; Michael J Droller; Edward Messing; Ashish M Kamat Journal: Urol Oncol Date: 2014-06-13 Impact factor: 3.498
Authors: Ashish M Kamat; Jason R Gee; Colin P N Dinney; H Barton Grossman; David A Swanson; Randall E Millikan; Michelle A Detry; Tracy L Robinson; Louis L Pisters Journal: J Urol Date: 2006-03 Impact factor: 7.450
Authors: Jeffrey K Wang; Stephen A Boorjian; John C Cheville; Simon P Kim; Robert F Tarrell; Prabin Thapa; Igor Frank Journal: World J Urol Date: 2012-11-07 Impact factor: 4.226
Authors: Ashish M Kamat; Colin P N Dinney; Jason R Gee; H Barton Grossman; Arlene O Siefker-Radtke; Pheroze Tamboli; Michelle A Detry; Tracy L Robinson; Louis L Pisters Journal: Cancer Date: 2007-07-01 Impact factor: 6.860
Authors: Srinivas Vourganti; Andrew Harbin; Eric A Singer; Brian Shuch; Adam R Metwalli; Piyush K Agarwal Journal: J Cancer Date: 2013-05-06 Impact factor: 4.207
Authors: Eva Compérat; Marek Babjuk; Ferran Algaba; Mahul Amin; Fadi Brimo; David Grignon; Donna Hansel; Ondra Hes; Bernard Malavaud; Victor Reuter; Theo van der Kwast Journal: World J Urol Date: 2018-09-14 Impact factor: 4.226
Authors: Marco Moschini; David D'Andrea; Stephan Korn; Yasin Irmak; Francesco Soria; Eva Compérat; Shahrokh F Shariat Journal: Nat Rev Urol Date: 2017-09-12 Impact factor: 14.432
Authors: Ofer N Gofrit; Vladimir Yutkin; Amos Shapiro; Galina Pizov; Kevin C Zorn; Guy Hidas; Ilan Gielchinsky; Mordechai Duvdevani; Ezekiel H Landau; Dov Pode Journal: Front Oncol Date: 2016-03-15 Impact factor: 6.244