Long-Term Follow-up of Patients with Stage T1 High-Grade Transitional Cell Carcinoma Managed by Bacille Calmette-Guérin Immunotherapy
David Margela, b, Corresponding Author Contact Information, E-mail The Corresponding Author, Raanan Tala, b, Shai Golana, b, Dani Kedara, b, Dov Engelsteina, b and Jack Baniela, b
aInstitute of Urology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel
bTel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
Received 23 February 2006; accepted 8 September 2006. Available online 30 January 2007.
To report the long-term outcome of patients with Stage T1 high-grade transitional cell carcinoma of the bladder treated initially by transurethral resection and adjuvant intravesical bacille Calmette-Guérin.
From June 1984 to November 1995, 78 consecutive patients with Stage T1 high-grade bladder cancer underwent transurethral resection and adjuvant intravesical bacille Calmette-Guérin therapy. The results at the interim follow-up (median 56 months) were reported in 1998. The median duration of follow-up for the present study was 107 months (range 16 to 238). The endpoints were tumor recurrence (Stage Ta, T1, or Tis), tumor progression (to T2 or greater), and disease-specific survival.
Of the 78 patients, 34 (44%) were alive for the present analysis and 44 (56%) had died, 12 (16%) of transitional cell carcinoma and 32 (72%) of other causes. Recurrence was documented in 27 patients (35%) at a median of 8.5 months (range 5 to 129) after treatment, and progression in 14 patients (18%) at a median of 31.4 months (range 5 to 88) after treatment. The 2, 5, and 10-year recurrence-free survival and progression-free survival rates were 76%, 72%, and 62% and 92%, 82%, and 80%, respectively. The corresponding disease-free survival rates were 99%, 90%, and 85%. Disease progression occurred in 10 (37%) of 27 patients with recurrence, of whom 9 died. Of the 14 patients with disease progression, 12 died of their disease.
Bacille Calmette-Guérin is an effective conservative treatment for patients with Stage T1 high-grade bladder cancer. More than one half the recurrences appeared within the first year, but a small risk remains throughout the patient’s life. Progression during follow-up appears to carry a high risk of cancer-specific death.
Yeah the statistics can be kind of hairy. I think that they probably didn't have very many T1 G2's in the EORTC study (if any) because it seems to give the same statistical prognosis as the T1 G1's.
I don't believe the 52% statistic. You should read the supporting studies for the EORTC risk anaysis program (I have a copy) - pretty good stuff. I was diagnosed with a single T1G3 (2cm) about a year ago and have poured over the statistics like you seem to be doing. EORTC tables were the best data I was able to find. I would guess that your stats would be somewhere between the 6% quoted for the T1G1's and the 17% quoted for the T1G3's for 5 year probablity of progression.
The 52% statistic could refer to untreated BC (i.e. no BCG and/or no TURB), or it could refer to T1G2's with co-contaminant CIS (which seems to have a worse prognosis). I'm just guessing here as I have not seen the reference.
Diagnosed T1G3 - 3/01/06
37 yo, Seattle, WA
In the EORTC Bladder Risk Table
A tumor like I had (T1, G2) has a .06 chance of progression after 5 years.
I'm guessing this means 6%
In the book 100 Questions and Answers About Bladder Cancer (Ellsworth & Carswell), they say a tumor with a grade of G2 has a 52% chance of becoming invassive.
Seems like a large discrepency. I'd like to go with the first statistic but can anyone explain the big difference?
Thanks, Bob P.