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Confusing statistics?
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. -
8 Replies
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Chris, maybe I’ve got the grading wrong. I’ve got another cystoscope (my 3 mo. follow up) next Wednesday, so I’ll double check. The doctor didn’t seem worried at all so maybe I’m mistaken about the grade. Maybe it was T1G1? I know it wasn’t TaG1; there was something elevated.
I’ll let you know.
Bob P -
Hmmmm, Bob I would seriously get a second opinion about not getting BCG for a T1G2. Maybe your doc knows what he is talking about, but?
I would at least look into the “induction” 6-weekly treatments of BCG. Get a second and third opinion. Generally your tumor would fall in the “Intermediate” risk zone, I would prefer conservative overtreatment than undertreatment. Your doctor may be waiting for a recurrance before bumping you up to the “High risk category” and advising BCG.
Low ( TaG1, T1G1 unique)
Intermediate (T1G1 multiple, TaG2,T1G2 unique)
High (T1G2 multiple, G3, +Tis)
Chris A.
Diagnosed T1G3 – 3/01/06
37 yo, Seattle, WA
Yes, it was interesting but they seem to be talking about G3 with BCG treatment. My dr. didn’t recommed BCG since it was only T1G2.
That part about 40% of T1 diagnosis being understaged and muscle invasive was a little scary. But maybe, again, that is G3 not G1 or G2?
Excellent article Wendy – Thank you! – As Bob can see for this study, the long term outcomes for T1G3 was like 80% (10 year – progression free) – probably even better long-term odds for a T1G2.
Chris A.
Diagnosed T1G3 – 3/01/06
37 yo, Seattle, WA
I had my first follow-up from my surgery with Dr. Stein at USC/Norris last week, and I asked him point-black what chance my cancer had of popping up again in the next five years. The American Cancer Society has pretty grim numbers for my situation–T3aN1M0.
Dr. Stein said 50%, which are much better odds than the ACS.
When I asked him why there was such a difference, he said that, quite frankly, they get better results at Norris.
Which is a pretty good reason to choose the best hospital and surgeon you can find.
Plus, and this is no small plus, Dr. Stein is a great person as well as an amazing surgeon. I couldn’t be more fortunate that my urologist here in Santa Barbara recommended him.
“Standing on my Head”––my chemo journal
T3a Grade 4 N+M0
RC at USC/Norris June 23, 2006 by Dr. John Stein
Thanks Christopher and Wendy. and I’ll check out that article Wendy.
Bob P
There is a strange lack of long term studies for T1 tumors, but an excellent article has recently been published on the subject of T1 tumors treated with BCG:
Urology
Volume 69, Issue 1 , January 2007, Pages 78-82
For the full article, online free:
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VJW-4MY1VKJ-W&_user=10&_coverDate=01%2F31%2F2007&_rdoc=25&_fmt=full&_orig=browse&_srch=doc-info(%23toc%236105%232007%23999309998%23643145%23FLA%23display%23Volume)&_cdi=6105&_sort=d&_docanchor=&view=c&_ct=64&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c4eb62609ecf93b0cba74b87d8d9b06cLong-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, baInstitute of Urology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel
bTel Aviv University Sackler Faculty of Medicine, Tel Aviv, IsraelReceived 23 February 2006; accepted 8 September 2006. Available online 30 January 2007.
Abstract
ObjectivesTo 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.
MethodsFrom 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.
ResultsOf 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.
ConclusionsBacille 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.
Bob,
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.
Chris A.
Diagnosed T1G3 – 3/01/06
37 yo, Seattle, WASign In to reply.
