Conservative management of T1G3 transitional cell carcinoma of the bladder. Risk factor analysis in 165 selected patients

INTRODUCTION AND OBJECTIVE: The management of TlG3 transitional cell carcinoma of the bladder (TCCB), is still controversial. Some Authors support an immediate radical cystectomy. BCG is considered the treatment of choice. Limited encouraging experiences are reported with intravesical chemotherapy. Objectives; Evaluating a selected population of 165 patients with TlG3 TCCB, in absence of Tis, treated conservatively with TUR plus adjuvant intravesical therapy. METHODS: Between January 1976 and December 1999, 165 patients with TlG3 bladder tumors were treated by TUR plus adjuvant intravesical therapy. Patients with previuos T1G3, Tis, more than 3 tumors or greater than 3 em were excluded. A sequential combination of mitomycin C and epirubicin was adopted in 91 patients (55%). BCG or other agents were used intravesically in 28 (17%) and 46 (28%) patients respectively. In case of Ta-Tl recurrence, TUR was repeated and one year of adjuvant intravesical therapy completed. Patients went off study if Tis or invasive tumor (T-category over TI) were detected. Age (less or more than 70), previuos history, multiplicity, time to recurrence, adjuvant therapy were considered in multivariate analysis. RESULTS: At a mean follow-up period of 48 months (12- 240 months), 74 patients (44.8%) recurred. The recurring tumor was Tl in 32 (19%) cases and TlG3 in 23 cases (14%). In 8 additional patients (5%) a Tis was detected. Fourteen patients (8.4%) progressed and 10 patients (6%) underwent cystectomy. Median progression-free survival was 149 months. Twenty-three patients (14%) died, 9 (5.5%) of whom due to bladder cancer. Median overall survival was 144 months, Recurrence was found related only to number of the tumors (p=0.0007) and to BCG (p=O.0013). No factor was found significantly correlated to progression. Previous history (p=0.0021), recurrence after adjuvant therapy (p<O.OOOl), and progression (p<O.OOOl),were statistically related to survival. CONCLUSIONS; If no concomitant Tis exists a conservative approach is a legitimate option as an initial treatment of patients with primary TlG3 bladder tumors. Time to progression and overall survival are comparable to those obtained by cystectomy. Recurrence is statistically influenced by initial number of tumors and BCG therapy. Mortality is significantly higher in patients with previous bladder tumors and/or showing recurrence and progression.