title: Characteristics and outcomes of patients with clinical T1 grade 3 urothelial carcinoma treated with radical cystectomy: results from an international cohort.
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).
  
  
  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.
authors.affiliation: Caritas-St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Eila
authors.initials: E
authors.lastname: Skinner
authors.forename: Stefan
authors.initials: S
authors.lastname: Denzinger
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Bjoern G
authors.initials: BG
authors.lastname: Volkmer
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Otto
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Izawa
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Seth
authors.initials: S
authors.lastname: Lerner
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Mark
authors.initials: M
authors.lastname: Schoenberg
authors.forename: Ashish
authors.initials: A
authors.lastname: Kamat
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: 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*