title: Reexamining treatment of high-grade T1 bladder cancer according to depth of lamina propria invasion: a prospective trial of 200 patients.
abstract: BACKGROUND
  Management of high-grade T1 (HGT1) bladder cancer represents a major challenge. We studied a treatment strategy according to substaging by depth of lamina propria invasion.
  
  
  METHODS
  In this prospective observational cohort study, patients received initial transurethral resection (TUR), mitomycin-C, and BCG. Subjects with shallower lamina propria invasion (HGT1a) were followed without further surgery, whereas subjects with HGT1b received a second TUR. Association of clinical and histological features with outcomes (primary: progression; secondary: recurrence and cancer-specific survival) was assessed using Cox regression.
  
  
  RESULTS
  Median age was 71 years; 89.5% were males, with 89 (44.5%) cases T1a and 111 (55.5%) T1b. At median follow-up of 71 months, disease progression was observed in 31 (15.5%) and in univariate analysis, substaging, carcinoma in situ, tumour size, and tumour pattern predicted progression. On multivariate analysis only substaging, associated carcinoma in situ, and tumour size remained significant for progression.
  
  
  CONCLUSIONS
  In HGT1 bladder cancer, the strategy of performing a second TUR only in T1b cases results in a global low progression rate of 15.5%. Tumours deeply invading the lamina propria (HGT1b) showed a three-fold increase in risk of progression. Substaging should be routinely evaluated, with HGT1b cases being thoroughly evaluated for cystectomy. Inclusion in the TNM system should also be carefully considered.
authors.affiliation: Department of Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: A
authors.initials: A
authors.lastname: Orsola
authors.affiliation: Departments of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: L
authors.initials: L
authors.lastname: Werner
authors.affiliation: Department of Pathology, Vall d'Hebron Hospital, Barcelona 08035, Spain.
authors.forename: I
authors.initials: I
authors.lastname: de Torres
authors.affiliation: University of Massachusetts Medical School, Worcester, MA 01655, USA.
authors.forename: W
authors.initials: W
authors.lastname: Martin-Doyle
authors.affiliation: Department of Urology, Vall d'Hebron Hospital, Barcelona 08035, Spain.
authors.forename: C X
authors.initials: CX
authors.lastname: Raventos
authors.affiliation: Department of Urology, Vall d'Hebron Hospital, Barcelona 08035, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Lozano
authors.affiliation: Department of Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Mullane
authors.affiliation: 1] Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA 02215, USA [2] Division of Urology, Brigham and Women's Hospital, Boston, MA 02215, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Leow
authors.affiliation: Department of Pathology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Barletta
authors.affiliation: Department of Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: J
authors.initials: J
authors.lastname: Bellmunt
authors.affiliation: Department of Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: J
authors.initials: J
authors.lastname: Morote
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012086:Reoperation; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D014551:Urinary Tract / Q000473:pathology*