Back to 2015 Joint Annual Meeting

Introduction:
There is uncertainty regarding optimal management of patients with Grade 3, T1 (G3T1) transitional cell carcinoma (TCC) of the bladder. Here, we review our series of patients with G3T1 TCC and identify risk factors for mortality and disease progression.
Materials & Methods:
156 patients were confirmed to have G3T1 TCC without muscle invasion or nodal/metastatic progression. Disease progression was defined as the subsequent invasion of cancer into the muscularis propria or deeper, adjacent organs, or spread to distant sites. Conservative management entailed TURBT with intravesical BCG. Risk factors for progression and mortality, such as carcinoma in situ (CIS) and lymphovascular invasion (LVI), were assessed.
Results:
Mean age was 68 years (28-89 years) with median follow-up of 76 months (1-141 months). Cystectomy was performed in 54 patients; 19 as primary therapy and 35 for disease progression. CIS was associated with higher rates of disease progression (5yr: 68% vs. 32%, p<0.0001), as was LVI (5yr: 74% vs. 37%, p<0.0001). On multivariable analysis, both CIS and LVI were associated with disease progression (HR 2.69 and HR 2.65, respectively, both p<0.0001). CIS and LVI also conferred a worse 5yr cancer-specific mortality (CIS: 63% vs. 33%, p=0.0004; LVI: 53% vs. 47%, p=0.04), which was confirmed with multivariable analysis (CIS: HR 2.6, p=0.0005 and LVI: HR 2.7, 0.0002).
Conclusions:
High-risk features such as CIS and LVI are associated with disease progression and cancer-specific mortality in patients with G3T1 TCC. Despite initial cystectomy, patients with G3T1 TCC were at risk for surgical upstaging and subsequent metastases.