Predicting cancer progression in patients with stage T1 bladder carcinoma

Purpose: A significant number of patients with stage T1 bladder carcinoma a re at risk for cancer progression. We sought to identify factors associated with cancer progression in a series of patients with stage T1 bladder carc inoma treated with a contemporary therapeutic approach. Patients and Methods: The study population consisted of 83 consecutive pati ents in whom stage T1 bladder carcinoma wets diagnosed at the Mayo Clinic b etween 1987 and 1992, All patients underwent trans-urethral resection of th e bladder (TURB) and had histologic confirmation of the diagnosis. The mean age war 71 years (range, 47 to 94 years), The male-to-female ratio was 3.9 :1. The mean length of follow-up was 5.2 years (range, 1 day to 10.4 years) , The depth of lamina propria invasion in the TURB specimens was measured w ith an ocular micrometer. Cancer progression was defined as the development of muscle-invasive or more advanced stage carcinoma, distant metastasis, o r death from bladder cancer. Results: The overall 5- and 7-year progression-free survival Kites were 82% and 80%, respectively The depth of invasion in the TURB specimens was asso ciated with cancer progression (hazards ratio, 1.6 for doubling of depth of invasion; 95% confidence interval, 1.03 to 2.4; P = .037), The 5-year prog ression-free survival rate for patients with depth of inversion of greater than or equal to 1.5 mm was 67%, compared with 93% for those with depth of invasion of less than 1.5 mm (P = .009). No other variable, including age, sex, tobacco use, alcohol use, the presence of carcinoma-in-situ, histologi c grade, lymphocytic infiltration, or muscularis mucosae invasion, was asso ciated with cancer progression, Conclusion: The depth of invasion in the TURB specimens, measured with a mi crometer, is predictive of cancer progression in patients with stage T1 bla dder carcinoma. (C) 1999 by American Society of Clinical Oncology.