BERKELEY, CA (UroToday.com) - According to the British Journal of Urology in a recent article by Lambert and collaborators the increased use of intravesical treatments for non-muscle invasive bladder cancer is associated with worse survival in patients with T1 disease despite cystectomy for disease progression or persistent disease after intravesical therapy.

The researchers used the Urologic Oncology database at Columbia University. Out of 505 total patients who underwent a radical cystectomy from 1990-present 104 had initial T1 disease. The authors divided the group into two time periods: before1998 (early) and after 1998 (late). The mean number of intravesical treatments per patient increased from 0.53 to 1.2 in the early and late groups, respectively (p=0.016). 28 of 38 (74%) patients in the early group and 20 of 47(43%) patients in the late group underwent cystectomy without any intravesical therapy (p=0.004).

The disease-free survival for patients who had a radical cystectomy in the early vs. late group at 5 years was 70% and 40%, respectively. Additionally, the early group had a worse overall and cancer specific survival than the late group. The survival curves were statistically controlled for confounders including date of surgery, age, and gender.

The authors hypothesize that prolonged use of intravesical therapy to preserve bladder function may forestall definitive therapy and result in potentially preventable deaths. They recommend early cystectomy in those patients who have initial high risk tumor characteristics or who have early failure to intravesical therapy.

Lambert EH, Pierorazio PM, Olsson CA, Benson MC, McKiernan JM and Poon S

BJU International. 100(1): 33-36, July 2007
doi:10.1111/j.1464-410X.2007.06912.x

UroToday.com Bladder Cancer Section

Written by David P. Wood, MD, a Contributing Editor with UroToday.

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