title: Clinical outcome in a contemporary series of restaged patients with clinical T1 bladder cancer.
abstract: OBJECTIVE
  To evaluate the indications for early and deferred cystectomy and to report the impact of this tailored approach on survival.
  
  
  METHODS
  We retrospectively studied 523 patients seen at our institution who were initially diagnosed with T1 disease between 1990 and 2007.
  
  
  METHODS
  Variables analyzed included age, gender, multifocality, multifocal T1 disease, carcinoma in situ, grade, recurrence rate, and restaging status. End points were overall and disease-specific survival.
  
  
  CONCLUSIONS
  A restaging transurethral resection (TUR) was performed in 523 patients. Of the patients who underwent restaging, 106 (20%) were upstaged to muscle-invasive disease and 417 patients were considered true clinical T1 (cT1); 84 of the latter group underwent immediate cystectomy. The median follow-up for survivors was 4.3 yr. The cumulative incidence of disease-specific death at 5 yr was 8% (95% confidence interval [CI], 5-13%), 10% (95% CI, 5-17%), and 44% (95% CI, 35-56%) for those restaged with lower than T1, T1, and T2 disease, respectively. Immediate cystectomy was more likely in patients with cT1 disease at restaging than in those with disease lower than cT1, but there were no other obvious differences in clinical characteristics between those with and without immediate cystectomy. Survival was not statistically different for patients who underwent an immediate cystectomy versus those who were maintained on surveillance with deferred cystectomy if deemed appropriate. Of 333 patients who did not undergo immediate cystectomy, 59 had a deferred cystectomy, and the likelihood of deferred cystectomy was greater in those with T1 disease on restaging TUR (hazard ratio: 2.40; 95% CI, 1.43-4.01; p=0.001).
  
  
  CONCLUSIONS
  Restaging TUR should be performed in patients diagnosed with cT1 bladder cancer to improve staging accuracy. Patients with T1 disease on restaging are at higher risk of progression and should be considered for early cystectomy.
authors.affiliation: Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. dalbagng@mskcc.org
authors.forename: Guido
authors.initials: G
authors.lastname: Dalbagni
authors.forename: Kinjal
authors.initials: K
authors.lastname: Vora
authors.forename: Matthew
authors.initials: M
authors.lastname: Kaag
authors.forename: Angel
authors.initials: A
authors.lastname: Cronin
authors.forename: Bernard
authors.initials: B
authors.lastname: Bochner
authors.forename: S Machele
authors.initials: SM
authors.lastname: Donat
authors.forename: Harry W
authors.initials: HW
authors.lastname: Herr
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000401:mortality*; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery