title: Clinical outcome of conservative therapy for stage T1, grade 3 transitional cell carcinoma of the bladder.
abstract: BACKGROUND
  The objective of this study was to retrospectively investigate the effectiveness of transurethral resection of bladder tumor (TURBT) and intravesical instillation therapy for stage T1, grade 3 (T1G3) transitional cell carcinoma (TCC) of the urinary bladder.
  
  
  METHODS
  Between January 1995 and December 1997, 97 patients with T1G3 TCC of the urinary bladder were treated by TURBT and adjuvant intravesical instillation with bacillus Calmette-Guérin (BCG) or other anticancer agents. The recurrence-free survival rates were evaluated according to several clinicopathological factors. The cases that progressed to muscle invasive disease were also analysed.
  
  
  RESULTS
  In this series, the median follow-up period was 25 months (range, 5- 41) after the initial TURBT. Intravesical recurrence was noted in 44 patients (45%), and the 1, 2, and 3 year recurrence-free survival rates were 72%, 58%, and 42%, respectively. Multivariate analyses revealed that the risk of intravesical recurrence was significantly higher for patients who did not receive BCG therapy, irrespective of age, gender, tumor size, multiplicity, pathological stage, concomitant carcinoma in situ, and lymphovascular involvement. Moreover, after a median of 10 months, disease progression occurred in seven patients (7%), of which only one patient was treated by BCG therapy after initial TURBT.
  
  
  CONCLUSIONS
  These findings suggest that intravesical instillation with BCG combined with TURBT is an effective conservative treatment for T1G3 TCC of the bladder. Patients with negative prognostic factors should be treated by BCG rather than other anticancer agents after TURBT.
authors.affiliation: Department of Urology, Kobe University School of Medicine, Kobe, Japan. hara@med.kobe-u.ac.jp
authors.forename: Isao
authors.initials: I
authors.lastname: Hara
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miyake
authors.forename: Yoshizumi
authors.initials: Y
authors.lastname: Takechi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Eto
authors.forename: Akinobu
authors.initials: A
authors.lastname: Gotoh
authors.forename: Masato
authors.initials: M
authors.lastname: Fujisawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okada
authors.forename: Soichi
authors.initials: S
authors.lastname: Arakawa
authors.forename: Sadao
authors.initials: S
authors.lastname: Kamidono
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D001500:BCG Vaccine / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000276:Adjuvants, Immunologic; D000903:Antibiotics, Antineoplastic; D001500:BCG Vaccine; D016685:Mitomycin; D004317:Doxorubicin; C027260:pirarubicin