T1-BLADDER CARCINOMA - INDICATION FOR TRA NSURETHRAL ELECTRORESECTIONOR PRIMARY RADICAL CYSTECTOMY

The therapy guidelines for T1-urothelial carcinomas of the urinary bla dder are not uniform. In a retrospective analysis, the clinical data o f 88 patients with T1-bladder carcinoma treated only with TUR were com pared to the data of 45 patients with radical cystectomy for T1-bladde r carcinoma. The mean follow-up was 54 +/- 39 (12-144) months in the T UR group and 34 +/- 22 (12-96) months in the cystectomy group. The ris k profile of both groups was similar. In the TUR group, 73.9% of the t umors recurred, the progression rate was 37.5%, and the total mortalit y rate 29.5%. In the cystectomy group, the total mortality of 13% was significantly lower (p=0.0392) than in the TUR group. The mortality ra tes of patients with T1 G2 (p=0.0286) and primary T1-tumors (p=0.0017) were significantly lower following cystectomy than following TUR. Loc al recurrences or operative mortality did not occur in the cystectomy group. In conclusion we recommend TUR with recurrence prophylaxis for T1 G1 and primary unilocular T1 G2 carcinomas. For multilocular or rec urrent T1 G2 and for all T1 G3 carcinomas, radical cystectomy should b e performed.