Journal article
A longitudinal single center analysis of T1HG bladder cancer: An 18 year experience
Urologic oncology, Vol.40(11), pp.491.e1-491.e9
11/01/2022
DOI: 10.1016/j.urolonc.2022.06.007
PMID: 35831215
Abstract
Objectives: To re-evaluate the treatment of T1HG bladder cancer by analyzing our experience over 18 years. Methods and Materials: An IRB-approved, single-institution retrospective review was performed of all patients with T1HG bladder cancer between August 1999 and July 2017. We assessed clinicopathologic characteristics, treatment history (including intravesical therapy, cystectomy, systemic chemotherapy, and radiation), and oncologic outcomes. Results: We identified 191 patients with T1HG. Five patients underwent cystectomy at diagnosis. The five-year recurrence-free survival (RFS) for the 186 patients who initially underwent bladder sparing treatments was 50% (95% CI: 41%-58%). There were 83 patients (45%) with disease recurrence; median time to recurrence was 6.7 months (IQR: 4.9-17.5). Disease characteristics at initial recurrence was T2 or greater in 8 patients (10%), T1HG in 19 (23%), CIS in 30 (36%), TaHG in 10 (12%), T1 low-grade (LG) in 1 (1%), and TaLG in 15 (18%). For patients with no prior recurrences, neither re-resection (P = 0.12), receipt of induction therapy (P = 0.81), prostatic urethra positivity (P = 0.51), or age (P = 0.34) were significantly associated with risk of recurrence. Similarly, patients with a single recurrence also fared well without identifiable risk factors. In fact, baseline hazard function analysis demonstrated no differences in RFS comparing patients strat-ified by 0, 1, and 2+ prior recurrences (P = 0.46). The five-year overall survival (OS) was 76% (95% CI: 68%-82%), and median OS was 127 months. The five-year cancer-specific survival was 86% (95% CI: 78%-91%) for the overall cohort. Five-year cystectomy-free sur-vival for patients with BCG responsive disease and unresponsive disease was 95% (95% CI: 85%-98%) and 72% (95% CI: 52%-84%), respectively. Conclusion: For patients who recurred after intravesical therapy, including those with recurrent T1 disease, additional induction courses of intravesical therapy did not negatively affect oncologic outcomes. Pathology of initial recurrence was not found to be a statistically sig-nificant risk factor for future recurrence. These findings suggest that BCG-unresponsive disease does not necessarily require immediate cys-tectomy. A multicenter, pragmatically designed evaluation in a contemporary cohort would more validly interrogate this important patient population. (C) 2022 Elsevier Inc. All rights reserved.
Details
- Title: Subtitle
- A longitudinal single center analysis of T1HG bladder cancer: An 18 year experience
- Creators
- Courtney Yong - University of IowaSarah L. Mott - 01IOWA_INST___Holden_Comprehensive_Cancer_CenterRyan L. Steinberg - University of Iowa Hospitals and ClinicsVignesh T. Packiam - University of Iowa Hospitals and ClinicsMichael A. O'Donnell - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Urologic oncology, Vol.40(11), pp.491.e1-491.e9
- Publisher
- Elsevier
- DOI
- 10.1016/j.urolonc.2022.06.007
- PMID
- 35831215
- ISSN
- 1078-1439
- eISSN
- 1873-2496
- Number of pages
- 9
- Grant note
- John & Carol Walter Family Foundation
- Language
- English
- Date published
- 11/01/2022
- Academic Unit
- Urology
- Record Identifier
- 9984319970602771
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