MD MPH Case Western/University Hospitals Cleveland Medical Center
Introduction: Because T1 can exhibits such stark variability in biologic and histopathologic characteristics, we examined the clinical differences in mortality and recurrence-free survival in patients diagnosed with non-full thickness stage T1 bladder compared patients with full-thickness lamina propria stage T1 and stage T2 cancer.
Methods: We identified 2786 bladder cancer patients who underwent transurethral resection of bladder tumor ( TURBT) at our institution between 1995 to 2015. Stage T1 bladder tumors were subclassified into two groups based on proximity of the tumor to the detrusor muscle: the advanced T1 (A-T1) tumor group, comprised of tumors that invaded the full thickness of lamina propria and the superficial T1 (S-T1) group, comprised of tumors that invaded the lamina propria but were not immediately adjacent to detrusor muscle. 154 patients were selected for the study, classified as S-T1 (n=79), A-T1 (n=20) and T2 (n=55). Recurrence free survival was assessed using Kaplan-Meier (KM)method and compared with the log-rank test.
Results: The characteristics of 154 patients included in the study are summarized in Table 1. Only 11(25%) of patient underwent neoadjuvant chemotherapy prior to cystectomy, with additional 16 (36.4%) undergoing adjuvant therapy. Compared to S-T1 patients, A-T1 and T2 patients experienced an increased rate of mortality [25(31.6%)vs 10(50%) vs 30(54.5%), p=0.023) during the follow up period. Patients with A-T1 disease experienced worst survival out of the three cohorts, as evidence by Kaplan Meier curve, with only 28% (95% CI 13-54%) survival at 60 months after the diagnosis, as compared to 68% (95% CI 53-79%) in S-T1 and 49%(95% CI 35-62) in T2 disease. When evaluating risk factors responsible for increased morality, age was found to be associated with increased risk of death with HR 1.054(1-026-1.083), while CIS, multifocality, and gender were not found to be predictors for worse outcomes. S-T1 was found to be protective with HR 0.346(0.161-0.743), as compared to A-T1 and T2 disease for mortality.
Conclusions: In conclusion our data points to strong evidence that increased depth of tumor invasion in T1 disease is a strong risk factor for increased mortality and decreased recurrence free survival. Source of
