T1 bladder cancer in Norway: treatment and survival.

Evaluation of treatment and survival of pT1 stage (T1) bladder cancer (BC) patients diagnosed with transitional cell carcinoma of the urinary bladder in Norway.

According to the Cancer Registry of Norway, 1,108 patients were diagnosed with T1 BC between 2008-2012. Information on surgical and medical procedures was provided by the Norwegian Patients Registry. Regression and survival models were applied to characterize patients receiving bacillus Calmette-Guerin (BCG) and radical cystectomy (RC) as early and delayed treatment and to estimate overall and cause specific survival rates (OS; CSS). Adjustments for sex, age, WHO grade and concomitant cis were made.

In total, 449 (41%) patients received BCG treatment, 162 (15%) as early treatment. RC represented the early treatment in 96 (9%) patients and the delayed treatment in 84 (8%). Overall, 850 (77%) patients received neither BCG nor RC as early treatment, of whom 287 (26%) were treated with BCG and 66 (6%) with RC during follow-up. Patients <75 years and patients with high grade tumors or concomitant cis were more likely to receive BCG and RC as early treatment. 5-year survival rates for all T1 BC patients were 84% (CSS) and 65% (OS). Delayed RC was associated with the lowest 5-year CSS (70%). After adjustment, gender did not impact treatment choice and CSS.

The use of BCG as early treatment indicates low adherence to existing guidelines. Delayed RC was associated with low survival rates. An increased focus on the management of T1 patients is needed in Norway.

Scandinavian journal of urology. 2020 Aug 12 [Epub ahead of print]

Augun Blindheim, Sophie Fosså, Ronnie Babigumira, Tor Å Myklebust, Erik Haug, Carl J Arum, Bettina K Andreassen

Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway., Department of Oncology, Medical Faculty, Oslo University Hospital & University of Oslo, Oslo, Norway., Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway., Department of Registration, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway., Department of Urology, Vestfold Hospital Trust, Tønsberg, Norway.