Characteristics and outcomes of patients with clinical T1 grade 3 urothelial carcinoma treated with radical cystectomy: results from an international cohort.
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).


METHODS
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.


METHODS
Patients' characteristics and outcome are evaluated.


CONCLUSIONS
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.
Fritsche
Hans-Martin
HM
Caritas-St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.
Burger
Maximilian
M
Svatek
Robert S
RS
Jeldres
Claudio
C
Karakiewicz
Pierre I
PI
Novara
Giacomo
G
Skinner
Eila
E
Denzinger
Stefan
S
Fradet
Yves
Y
Isbarn
Hendrik
H
Bastian
Patrick J
PJ
Volkmer
Bjoern G
BG
Montorsi
Francesco
F
Kassouf
Wassim
W
Tilki
Derya
D
Otto
Wolfgang
W
Capitanio
Umberto
U
Izawa
Jonathan I
JI
Ficarra
Vincenzo
V
Lerner
Seth
S
Sagalowsky
Arthur I
AI
Schoenberg
Mark
M
Kamat
Ashish
A
Dinney
Colin P
CP
Lotan
Yair
Y
Shariat
Shahrokh F
SF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*