PTU - Polskie Towarzystwo Urologiczne
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Bladder cancer pT1 G3 N0 M0 – Results of early cystectomy
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Krzysztof Kamecki, Jerzy Siekiera, Zbigniew Wolski, Witold Mikołajczak, Andrzej Petrus, Andrzej Wronczewski
Oddział Urologii Onkologicznej, Centrum Onkologii im. prof. F. Łukaszczyka w Bydgoszczy
Szpital Uniwersytecki Collegium Medicum UMK Katedra i Klinika Urologii Ogólnej, Onkologicznej i Dziecięcej w Bydgoszczy

summary

Introduction.

Transitional cell carcinoma classified as pT1G3 is more aggressive than other superficial bladder cancer (pTaG1-pT1G2). Although the aggressiveness of this tumor entity is well known, EAU guidelines recommend transurethral resection and consecutive bladder instillations with BCG as a first line therapy. With regard to literature, this concept allows preservation of the bladder in about one third of the patients. In another one third - cystectomy will be necessary during follow-up, and the last one third of the patients will progress to metastatic disease. Early cystectomy in pT1G3 bladder cancer may better improve longtime prognosis and oncological outcome.

Materials and methods.

All patients who underwent radical cystectomy for bladder cancer pT1G3 between 01/2006 and 01/2008 were evaluated. Data were analyzed concerning postoperative tumor stage with special interest to frequency of pT1G3, clinical understaging and lymph node involvement.

Results.

Of 74 patients who underwent radical cystectomy, 14 patients (19%) had a transitional cell carcinoma pT1G3 in the transurethral resection. 10/14 (71%) of these patients had a history of recurrent bladder cancer (pTaG1-pT1G2). Definitive histology after cystectomy showed no residual tumor (pT0) in 2/14 (14%), lower tumorstage (pTa) in 1/14 (7%) and residual pT1 carcinoma in 1/14 (7%). 10/14 (71%) of the patients were understaged and 3/10 (30%) of these showed lymph node metastases (N1-N2). Additionally, of the patients with a tumor stage < or = pT1G3, in the definitive specimen already no one had histologically proven regional lymph node metastases, 2 of these showed no tumor in the cystectomy specimen (pT0).

Conclusions.

Transitional cell carcinoma pT1G3 in transurethral resection justifies radical cystectomy as a primary therapy option. 71% of these patients are clinically understaged, and the carcinomas classified after TUR as pT1G3 already show lymph node metastases in 30%. Because of short follow-up (1-24 months) it is not possible to evaluate reliably survival ratios, but compared to bladder preservation therapy, it is allowed to expect better tumour-specific survival for pT1G3 carcinomas in a group of patients undergoing early cystectomy.