Predictors of oncological outcomes in T1G3 patients treated with BCG who undergo radical cystectomy

Vincenzo Serretta, Stéphane Larré, Anne J. Grotenhuis, Evanguelos Xylinas, Francesco Soria, Roy Mano, Palou, Eugene K. Cha, Tommaso Cai, Bas Van Rhijn, Steven Joniau, R. Jeffrey Karnes, Peter Ardelt, Marek Babjuk, John Varkarakis, Paolo Gontero, Nuria Malats, Guido Dalbagni, Per-Uno Malmstrom, Shahrokh F. ShariatSavino Di Stasi, Riccardo Bartoletti, Francesca Pisano, Jacques Irani, J. Alfred Witjes, Jack Baniel, Renzo Colombo, Richard Sylvester, Viktor Soukup, Alberto Briganti, Annunziata Briganti, Maria Francesca Pisano

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Abstract

Purpose To evaluate the oncological impact of postponing radical cystectomy (RC) to allow further conservative therapies prior to progression in a large multicentre retrospective cohort of T1-HG/G3 patients initially treated with BCG.Methods According to the time of RC, the population was divided into 3 groups: patients who did not progress to muscle-invasive disease, patients who progressed before radical cystectomy and patients who experienced progression at the time of radical cystectomy. Clinical and pathological outcomes were compared across the three groups.Results Of 2451 patients, 509 (20.8%) underwent RC. Patients with tumors > 3 cm or with CIS had earlier cystectomies (HR = 1.79, p = 0.001 and HR = 1.53, p = 0.02, respectively). Patients with tumors > 3 cm, multiple tumors or CIS had earlier T3/T4 or N + cystectomies. In patients who progressed, the timing of cystectomy did not affect the risk of T3/T4 or N + disease at RC. Patients with T3/T4 or N + disease at RC had a shorter disease-specific survival (HR = 4.38, p < 0.001), as did patients with CIS at cystectomy (HR = 2.39, p < 0.001). Patients who progressed prior to cystectomy had a shorter disease-specific survival than patients for whom progression was only detected at cystectomy (HR = 0.58, p = 0.024)Conclusions Patients treated with RC before experiencing progression to muscle-invasive disease harbor better oncological and survival outcomes compared to those who progressed before RC and to those upstaged at surgery. Tumor size and concomitant CIS at diagnosis are the main predictors of surgical treatment while tumor size, CIS and tumor multiplicity are associated with extravesical disease at surgery.
Original languageEnglish
Pages (from-to)1775-1781
Number of pages7
JournalWorld Journal of Urology
Volume36
Publication statusPublished - 2018

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All Science Journal Classification (ASJC) codes

  • Urology

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Serretta, V., Larré, S., Grotenhuis, A. J., Xylinas, E., Soria, F., Mano, R., Palou, Cha, E. K., Cai, T., Van Rhijn, B., Joniau, S., Karnes, R. J., Ardelt, P., Babjuk, M., Varkarakis, J., Gontero, P., Malats, N., Dalbagni, G., Malmstrom, P-U., ... Pisano, M. F. (2018). Predictors of oncological outcomes in T1G3 patients treated with BCG who undergo radical cystectomy. World Journal of Urology, 36, 1775-1781.