Early-Stage Bladder Cancer Surveillance Does Not Improve Survival If High-Risk Patients Are Permitted To Progress To Muscle Invasion

August 8, 2007 – 2:26 am | posted in Cancer / Oncology, Clinical Trials / Drug Trials, Urology / Nephrology

UroToday.com- According to the journal Urology, in a recent article by Lee and collaborators, surveillance cystoscopy for early-stage bladder cancer (cTIS-T1) did not alter the disease-free or overall survival of patients who progressed to cT2 disease compared to patients with denovo cT2 disease.

The paradigm of surveillance cystoscopy for early-stage bladder cancer (cTis-T1) is based on the belief that tumor recurrences will be detected at a curable stage and effectively treated. This would permit bladder preservation with conservative treatments using cystectomy to salvage patients with refractory or progressing disease. However, some tumors progress to muscle invasion during surveillance and cystectomy should provide a better outcome in patients with “early” cT2 disease compared with those with de novo cT2 disease. To determine if this paradigm was true, the authors evaluated 422 consecutive patients who underwent primary cystectomy for muscle-invasive bladder cancer. They compared the pathologic and survival outcomes of patients with high-risk early-stage disease who progressed to cT2 disease with those patients who had muscle-invasive tumors at presentation. All data was collected prospectively in an IRB approved database.

Of the 422 patients, 182 (44%) had cTis-T1 cancer at diagnosis but did not progress to cT2 disease (group 1), 69 patients (17%) had cTis-T1 that progressed to cT2 during surveillance (group 2), and 167 patients (40%) presented with cT2 tumors (group 3). Patients in Group 1 had significantly improved disease-free and overall survival compare to groups 1 and 2. Interestingly, the disease-free and overall survival between groups 2 and 3 were similar (P = 0.469 and P = 0.643), respectively. Importantly, groups 2 and 3 suffered from significant under-staging with almost 60% of cases being upstaged at the time of cystectomy.

The authors concluded that patients with disease progression to cT2 bladder cancer during surveillance have similar rates of pathologic understaging and survival after cystectomy as those with de novo cT2 disease. This suggests that our current regimen of surveillance cystoscopy for early-stage bladder cancer (CTIS-T1) is ineffective in patients who progress to cT2 disease, most likely from understaging of the primary tumor.

Lee CT, Dunn RL, Ingold C, Montie JE, Wood Jr DP

Urology. 69(6):1068-72, June 2007
doi:10.1016/j.urology.2007.02.064

Reported by UroToday.com Contributing Editor David P. Wood, MD

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