ORLANDO, FL USA (UroToday.com) - The American Urological Association (AUA) guidelines recommend repeat TUR in patients with T1 tumors given the 30% risk of muscle invasive disease detection on re-staging.
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The most recent practice guidelines from the AUA recommend intravesical therapy for the treatment of HGT1 disease, while the EAU guidelines categorize HGT1 disease as high-risk and recommend intravesical full-dose BCG instillation, with RC reserved for the treatment of specific subtypes of high-risk tumors. Despite evidence showing a high risk for tumor upstaging, the role of early radical cystectomy (RC) for HGT1 disease remains controversial.
Despite the wealth of compelling evidence in support of early RC for HGT1 disease, the vast majority of patients are still under treated; less than 5% of patients presenting with HGT1 disease undergo early RC. Dr. Charles Concodora and colleagues used the National Cancer Database to evaluate contemporary performance trends of early RC for T1HG disease and assess the burden of pathologic upstaging at the time of RC. Of over 53 000 patients diagnosed with T1HG disease, only 6.8% underwent early RC. Encouragingly, the proportion of patients undergoing RC increased over the study period (4.7%  versus 9.2% ). Following multivariable adjustment, Charlson/Deyo score, age, race/ethnicity, year of diagnosis, insurance, geographic region, and hospital type were associated with performance of early RC. Pathologic upstaging at RC occurred in 37.5% of patients, while 3.9% were down-staged to pT0 disease. In conclusion, HGT1 carcinoma of the bladder is a potentially lethal disease, and patients treated with early RC have a potential survival advantage. Among patients within the NCDB, the utilization of early RC has doubled from 1998 to 2010, but still remains at less than 10% for patients with HGT1 disease. 37.5% of patients that underwent early RC were pathologically upstaged to ≥ T2 disease, thus further supporting the role of early RC in select patients.
Click HERE to listen to Jeffrey J. Tomaszewski, MD, one of the authors of this study
Presented by Charles Concodora, MD at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Fox Chase Cancer Center, Philadelphia, PA USA
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com