Characteristics and Outcomes of Patients with Clinical T1 Grade 3 Urothelial Carcinoma Treated with Radical Cystectomy

Results from an International Cohort

Hans Martin Fritsche, Maximilian Burger, Robert S. Svatek, Claudio Jeldres, Pierre I. Karakiewicz, Giacomo Novara, Eila Skinner, Stefan Denzinger, Yves Fradet, Hendrik Isbarn, Patrick J. Bastian, Bjoern G. Volkmer, Francesco Montorsi, Wassim Kassouf, Derya Tilki, Wolfgang Otto, Umberto Capitanio, Jonathan I. Izawa, Vincenzo Ficarra, Seth Lerner & 6 others Arthur I. Sagalowsky, Mark P. Schoenberg, Ashish Kamat, Colin P. Dinney, Yair Lotan, Shahrokh F. Shariat

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Background: Management of T1 grade 3 (T1G3) urothelial carcinoma of the bladder (UCB), with its variable behaviour, represents one of the most difficult challenges for urologists and patients alike. Objective: To evaluate the characteristics and long-term outcome of patients with clinical T1G3 UCB treated with radical cystectomy (RC). Design, setting, and participants: Data from 1136 patients treated with RC for clinical T1G3 UCB without neoadjuvant chemotherapy were collected at 12 centres located in Europe, the United States, and Canada. Median age was 67 yr (range: 29-94), with a male-to-female ratio of 4:1. Measurements: Patients' characteristics and outcome are evaluated. Results and limitations: Of the 1136 patients, 33.4% had non-organ-confined stage at cystectomy, and 16.2% had lymph node (LN) metastasis; 49.7% were upstaged after RC to muscle-invasive disease, while 21.4% were downstaged to lower than T1G3. Within a median follow-up of 48 mo, 35.5% of patients died of metastatic UCB. Conclusions: Approximately half of the patients treated with RC without neoadjuvant chemotherapy for clinical T1G3 UCB are upstaged to muscle-invasive UCB. These rates support the inadequacy of clinical decision making based on current treatment paradigms and staging tools. Therefore, identification of patients with clinical T1G3 disease at high risk of disease progression is of the utmost importance, as these patients are likely to benefit from early RC.

Original languageEnglish (US)
Pages (from-to)300-309
Number of pages10
JournalEuropean Urology
Volume57
Issue number2
DOIs
StatePublished - Feb 2010
Externally publishedYes

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Cystectomy
Carcinoma
Urinary Bladder
3-monoiodothyronine
Drug Therapy
Muscles
Canada
Disease Progression
Lymph Nodes
Neoplasm Metastasis

Keywords

  • Bladder cancer
  • Radical cystectomy
  • Recurrence
  • Survival
  • T1
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Characteristics and Outcomes of Patients with Clinical T1 Grade 3 Urothelial Carcinoma Treated with Radical Cystectomy : Results from an International Cohort. / Fritsche, Hans Martin; Burger, Maximilian; Svatek, Robert S.; Jeldres, Claudio; Karakiewicz, Pierre I.; Novara, Giacomo; Skinner, Eila; Denzinger, Stefan; Fradet, Yves; Isbarn, Hendrik; Bastian, Patrick J.; Volkmer, Bjoern G.; Montorsi, Francesco; Kassouf, Wassim; Tilki, Derya; Otto, Wolfgang; Capitanio, Umberto; Izawa, Jonathan I.; Ficarra, Vincenzo; Lerner, Seth; Sagalowsky, Arthur I.; Schoenberg, Mark P.; Kamat, Ashish; Dinney, Colin P.; Lotan, Yair; Shariat, Shahrokh F.

In: European Urology, Vol. 57, No. 2, 02.2010, p. 300-309.

Research output: Contribution to journalArticle

Fritsche, HM, Burger, M, Svatek, RS, Jeldres, C, Karakiewicz, PI, Novara, G, Skinner, E, Denzinger, S, Fradet, Y, Isbarn, H, Bastian, PJ, Volkmer, BG, Montorsi, F, Kassouf, W, Tilki, D, Otto, W, Capitanio, U, Izawa, JI, Ficarra, V, Lerner, S, Sagalowsky, AI, Schoenberg, MP, Kamat, A, Dinney, CP, Lotan, Y & Shariat, SF 2010, 'Characteristics and Outcomes of Patients with Clinical T1 Grade 3 Urothelial Carcinoma Treated with Radical Cystectomy: Results from an International Cohort', European Urology, vol. 57, no. 2, pp. 300-309. https://doi.org/10.1016/j.eururo.2009.09.024
Fritsche, Hans Martin ; Burger, Maximilian ; Svatek, Robert S. ; Jeldres, Claudio ; Karakiewicz, Pierre I. ; Novara, Giacomo ; Skinner, Eila ; Denzinger, Stefan ; Fradet, Yves ; Isbarn, Hendrik ; Bastian, Patrick J. ; Volkmer, Bjoern G. ; Montorsi, Francesco ; Kassouf, Wassim ; Tilki, Derya ; Otto, Wolfgang ; Capitanio, Umberto ; Izawa, Jonathan I. ; Ficarra, Vincenzo ; Lerner, Seth ; Sagalowsky, Arthur I. ; Schoenberg, Mark P. ; Kamat, Ashish ; Dinney, Colin P. ; Lotan, Yair ; Shariat, Shahrokh F. / Characteristics and Outcomes of Patients with Clinical T1 Grade 3 Urothelial Carcinoma Treated with Radical Cystectomy : Results from an International Cohort. In: European Urology. 2010 ; Vol. 57, No. 2. pp. 300-309.
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T1 - Characteristics and Outcomes of Patients with Clinical T1 Grade 3 Urothelial Carcinoma Treated with Radical Cystectomy

T2 - Results from an International Cohort

AU - Fritsche, Hans Martin

AU - Burger, Maximilian

AU - Svatek, Robert S.

AU - Jeldres, Claudio

AU - Karakiewicz, Pierre I.

AU - Novara, Giacomo

AU - Skinner, Eila

AU - Denzinger, Stefan

AU - Fradet, Yves

AU - Isbarn, Hendrik

AU - Bastian, Patrick J.

AU - Volkmer, Bjoern G.

AU - Montorsi, Francesco

AU - Kassouf, Wassim

AU - Tilki, Derya

AU - Otto, Wolfgang

AU - Capitanio, Umberto

AU - Izawa, Jonathan I.

AU - Ficarra, Vincenzo

AU - Lerner, Seth

AU - Sagalowsky, Arthur I.

AU - Schoenberg, Mark P.

AU - Kamat, Ashish

AU - Dinney, Colin P.

AU - Lotan, Yair

AU - Shariat, Shahrokh F.

PY - 2010/2

Y1 - 2010/2

N2 - Background: Management of T1 grade 3 (T1G3) urothelial carcinoma of the bladder (UCB), with its variable behaviour, represents one of the most difficult challenges for urologists and patients alike. Objective: To evaluate the characteristics and long-term outcome of patients with clinical T1G3 UCB treated with radical cystectomy (RC). Design, setting, and participants: Data from 1136 patients treated with RC for clinical T1G3 UCB without neoadjuvant chemotherapy were collected at 12 centres located in Europe, the United States, and Canada. Median age was 67 yr (range: 29-94), with a male-to-female ratio of 4:1. Measurements: Patients' characteristics and outcome are evaluated. Results and limitations: Of the 1136 patients, 33.4% had non-organ-confined stage at cystectomy, and 16.2% had lymph node (LN) metastasis; 49.7% were upstaged after RC to muscle-invasive disease, while 21.4% were downstaged to lower than T1G3. Within a median follow-up of 48 mo, 35.5% of patients died of metastatic UCB. Conclusions: Approximately half of the patients treated with RC without neoadjuvant chemotherapy for clinical T1G3 UCB are upstaged to muscle-invasive UCB. These rates support the inadequacy of clinical decision making based on current treatment paradigms and staging tools. Therefore, identification of patients with clinical T1G3 disease at high risk of disease progression is of the utmost importance, as these patients are likely to benefit from early RC.

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KW - Recurrence

KW - Survival

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