title: Long-term cancer-specific outcomes of TaG1 urothelial carcinoma of the bladder.
abstract: BACKGROUND
  Few studies have investigated the natural history of TaG1 urothelial carcinoma of the bladder (UCB).
  
  
  OBJECTIVE
  To assess the long-term outcomes of patients with TaG1 UCB and the impact of immediate postoperative instillation of chemotherapy (IPIC).
  
  
  METHODS
  A retrospective analysis of 1447 patients with TaG1 UCB treated between 1996 and 2007 at eight centers. Median follow-up was 67.2 mo (interquartile range: 67.9). Patients were stratified into three European Association of Urology (EAU) guidelines risk categories; high-risk patients (n=11) were excluded.
  
  
  METHODS
  Transurethral resection of the bladder with or without IPIC.
  
  
  METHODS
  Univariable and multivariable Cox regression models addressed factors associated with disease recurrence, disease progression, death of disease, and any-cause death.
  
  
  CONCLUSIONS
  Of the 1436 patients, 601 (41.9%) and 835 (58.1%) were assigned to low- and intermediate-risk categories, respectively. The actuarial estimate of 5-yr recurrence-free survival was 56% (standard error: ± 1). Advancing age (p=0.04), tumor >3 cm (p=0.001), multiple tumors (p<0.001), and recurrent tumors (p<0.001) were independently associated with increased risk of disease recurrence, whereas IPIC was associated with decreased risk (p=0.001). The actuarial estimate of 5-yr progression-free survival was 95% ± 1. Advancing age (p<0.001) and multiple tumors (p=0.01) were independent risk factors for disease progression. Five-year cancer-specific survival was 98% ± 1. Advancing age (p=0.001) and previous recurrence (p=0.04) were associated with increased risk, whereas female gender (p=0.02) was associated with decreased risk of cancer-specific mortality. Compared with low-risk patients, intermediate-risk patients were at significantly higher risk of disease recurrence, disease progression, and cancer-specific mortality (all p<0.01). Limitations include the retrospective design of the study and the lack of a central pathology review.
  
  
  CONCLUSIONS
  TaG1 UCB patients experience heterogeneous risks of disease recurrence. We validated the EAU guidelines risk stratification in TaG1 UCB patients. IPIC was associated with a reduced risk of disease recurrence in patients with low- and intermediate-risk TaG1 UCB.
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, University Hospital Basel, Basel, Switzerland.
authors.forename: Malte
authors.initials: M
authors.lastname: Rieken
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: Luis
authors.initials: L
authors.lastname: Kluth
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Crivelli
authors.forename: James
authors.initials: J
authors.lastname: Chrystal
authors.forename: Talia
authors.initials: T
authors.lastname: Faison
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Sten
authors.initials: S
authors.lastname: Holmäng
authors.forename: Marek
authors.initials: M
authors.lastname: Babjuk
authors.forename: Harun
authors.initials: H
authors.lastname: Fajkovic
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Alexander
authors.initials: A
authors.lastname: Bachmann
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*
keywords: Immediate postoperative intravesical chemotherapy; Outcome assessment; TaG1 urothelial carcinoma of the bladder; Transurethral resection