Recurrence at Three Months and High-grade Recurrence as Prognostic Factor of Progression in Multivariate Analysis of T1G2 Bladder Tumors

• Published in: Urology (Ridgewood, N.J.) Vol. 73; no. 6; pp. 1313 - 1317
• Main Authors: Palou, Juan, Rodríguez-Rubio, Federico, Millán, Félix, Algaba, Ferran, Rodríguez-Faba, Oscar, Huguet, Jorge, Villavicencio, Humberto
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2009; Elsevier
• Subjects: Biological and medical sciences; Carcinoma, Transitional Cell - epidemiology; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Disease Progression; Female; Follow-Up Studies; Humans; Male; Medical sciences; Multivariate Analysis; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; Nephrology. Urinary tract diseases; Prognosis; Time Factors; Tumors of the urinary system; Urinary Bladder Neoplasms - epidemiology; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology; Nephrology; Relapse; Urinary system disease; Prognosis; Evolution; Bladder disease; Urinary tract disease; Multivariate analysis; Bladder tumor; Urology; High grade; High malignancy
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2008.12.047

Objectives To evaluate the risk factors for disease progression in the frequent subgroup of Stage T1G2 (World Health Organization 1973) bladder tumors using an analysis of a large cohort of patients with Stage T1G2 disease. Methods A cohort of 616 patients with Stage T1G2 were treated with transurethral resection and random bladder biopsies. The mean follow-up was 4.2 years. Univariate and multivariate analyses were done using Cox regression analysis. The independent variables were multiplicity, association with carcinoma in situ (CIS), tumor size, tumor recurrence at 3 or 6 months, tumor grade, and association with CIS at first recurrence. The dependent variable was progression to muscle-invasive disease. Results Progression to muscle-invasive disease was identified in 28 of the 616 patients (4.5%). On multivariate analysis, when considering recurrence at 3 months, this factor was the principal prognostic factor, with a relative risk of 4.0 (95% confidence interval 1.2-13.3), followed by the presence of high-grade disease or CIS at first recurrence (relative risk 2.8, 95% confidence interval 1.3-5.8) and CIS associated with the primary tumor (relative risk 1.8, 95% confidence interval 1.1-2.9). When considering recurrence at 6 months, more prognostic factors were involved for progression, including as multiple tumors, CIS associated with the primary tumor, recurrence at 6 months, and the presence of high-grade disease or CIS at the first recurrence. Conclusions In primary urothelial T1G2 bladder cancer, recurrence at 3 months was the main prognostic factor related to progression. Additional factors were the association of CIS with the primary tumor and the presence of high-grade disease and/or CIS at first recurrence.