Clinical outcome of patients with T1 micropapillary urothelial carcinoma of the bladder - Abstract

PURPOSE: To report cancer-specific outcomes of micropapillary NMIBC.

MATERIALS AND METHODS: The records of 36 patients restaged within three months of initial micropapillary NMIBC diagnosis were retrospectively reviewed. Early radical cystectomy ([RC] within a three-month landmark after restaging transurethral resection of bladder tumor [TURBT]), or conservative management (intravesical Bacillus Calmette-Guérin, surveillance, or deferred RC) was offered according to surgeon and patient preference. Cumulative incidence of cancer-specific mortality (CSM) and metastasis was estimated using Kaplan-Meier methods. Differences in cumulative incidence of CSM and metastasis between groups were tested using the log rank test.

RESULTS: Median patient age was 68 (interquartile range [IQR] 63, 77) years. Male-to-female ratio was 3:1. At restaging, all patients had ≤ cT1 disease. Fifteen (42%) patients underwent early RC; 21 (58%) conservative management. Median follow-up time from landmark for cancer-specific survivors was 3.1 years (IQR 1.1, 5.9). Five-year cumulative incidence of CSM was 17% in the early RC group and 25% in the conservative management group, with an absolute difference of 7% (95% confidence interval [CI]: -26%, 41%; p = 0.8). The 5-year cumulative incidence of metastasis was 21% and 34%, respectively, with an absolute difference of 13% (95% CI: -23%, 49%; p = 0.9). The extent of the micropapillary component was not significantly associated with CSM (p = 0.4) or metastasis (p = 0.9).

CONCLUSIONS: Using proper selection criteria, including patient and pathologic factors, certain patients with cT1 micropapillary UC managed conservatively were not found to have significantly worse outcomes compared to patients undergoing early radical cystectomy.

Written by:
Spaliviero M, Dalbagni G, Bochner BH, Poon BY, Huang H, Al-Ahmadie HA, Donahue TF, Taylor JM, Meeks JJ, Sjoberg DD, Donat SM, Reuter VE, Herr HW.   Are you the author?
Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.  

Reference: J Urol. 2014 Mar 3. pii: S0022-5347(14)02824-9.
doi: 10.1016/j.juro.2014.02.2565

PubMed Abstract
PMID: 24603101 Bladder Cancer Section