title: Clinical outcomes of cT1 micropapillary bladder cancer.
abstract: OBJECTIVE
  While many urologists recommend radical cystectomy for micropapillary bladder cancer invading the lamina propria (cT1), contradictory small reports exist on the efficacy of conservative management with intravesical bacillus Calmette-Guérin for this disease. We report our updated experience in what to our knowledge is the largest series of patients with cT1 micropapillary bladder cancer.
  
  
  METHODS
  An institutional review board approved review of our cancer database identified 283 patients with micropapillary bladder cancer, including 72 staged with cT1N0M0 disease at diagnosis and initiation of therapy. Survival analysis was performed using the Kaplan-Meier estimator and compared using the log rank test.
  
  
  RESULTS
  In this cohort of 72 patients 40 received primary intravesical bacillus Calmette-Guérin and 26 underwent up-front radical cystectomy. Of patients who received bacillus Calmette-Guérin 75%, 45% and 35% experienced disease recurrence, progression and lymph node metastasis, respectively. Patients treated with up-front cystectomy had improved survival compared to patients treated with primary bacillus Calmette-Guérin (5-year disease specific survival 100% vs 60% p = 0.006) and patients who underwent delayed cystectomy after recurrence (5-year disease specific survival 62%, p = 0.015). Prognosis was especially poor in patients who waited for progression before undergoing radical cystectomy with an estimated 5-year disease specific survival of only 24% and a median survival of 35 months. In patients treated with up-front cystectomy pathological up-staging was found in 27%, including 20% with lymph node metastasis.
  
  
  CONCLUSIONS
  While certain patients with T1 micropapillary bladder cancer may respond to intravesical bacillus Calmette-Guérin, survival is improved in those who undergo early radical cystectomy. Further molecular studies are needed to identify subsets of patients in whom the bladder can be safely spared.
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Willis
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Mario I
authors.initials: MI
authors.lastname: Fernandez
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Rian J
authors.initials: RJ
authors.lastname: Dickstein
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Sahil
authors.initials: S
authors.lastname: Parikh
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Jay B
authors.initials: JB
authors.lastname: Shah
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Guo
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Samuel
authors.initials: S
authors.lastname: Henderson
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Bogdan A
authors.initials: BA
authors.lastname: Czerniak
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
authors.affiliation: Departments of Urology and Pathology (CCG, SH, BAC), University of Texas M.D. Anderson Cancer Center, Houston, Texas. Electronic address: akamat@mdanderson.org.
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000368:Aged; D001500:BCG Vaccine / Q000627:therapeutic use*; D002291:Carcinoma, Papillary / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine
keywords: BCG vaccine; cystectomy; mortality; neoplasm invasiveness; urinary bladder