RELATIONSHIP AMONG CYSTECTOMY, MICROVESSEL DENSITY AND PROGNOSIS IN STAGE T1 TRANSITIONAL-CELL CARCINOMA OF THE BLADDER

Purpose: The selection of therapy for stage T1 bladder cancer is contr oversial, and reliable biomarkers that identify patients likely to req uire cystectomy for local disease control have not been established. W e evaluated our experience with T1 bladder cancer to determine whether early cystectomy improves prognosis, and whether microvessel density has prognostic value for T1 lesions and could be used for patient sele ction. Materials and Methods: We retrospectively reviewed the records of 88 patients with T1 transitional cell carcinoma of the bladder. Pat ient outcome was correlated with therapeutic intervention. Paraffin em bedded tissue from 54 patients was available for factor VIII immunohis tochemical staining for microvessel density quantification. Results: M edian followup was 48 months (range 12 to 239). Of the patients 34% ha d no tumor recurrence. The rates of recurrence only and progression to higher stage disease were 41 and 25%, respectively. The survival of p atients in whom disease progressed was diminished (p = 0.0002). Grade did not predict recurrence or progression nor did cystectomy provide a survival advantage. Microvessel density did not correlate with recurr ence or progression. Conclusions: Patients with T1 bladder cancer have a high risk of recurrence and progression. Tumor progression has a si gnificant negative impact on survival. Neither grade nor early tumor r ecurrence predicted disease progression, Because early cystectomy did not improve patient outcome, we suggest reserving cystectomy for patie nts with progression or disease refractory to local therapy. Microvess el density is not a prognostic marker for T1 bladder cancer and has no value in selecting patients with T1 disease for cystectomy.