The 3-month clinical response to intravesical therapy as a predictive factor for progression in patients with high risk superficial bladder cancer

Purpose: We analyzed the 3-month clinical response to intravesical therapy as a factor predictive of progression in patients with high risk superficia l bladder cancer. Material and Methods: We evaluated 191 patients with high risk superficial bladder cancer, 111 with secondary or associated bladder carcinoma in situ and 80 with stage T1 grade 3 disease who were treated with intravesical the rapy. We considered only clinically complete and no responses at the 3-mont h endoscopic study. To determine the predictive value of the 3-month clinic al response we differentiated progression into superficial and invasive typ es. Results: At a median followup of 73 months 91 patients (47.6%) had progress ion, which was superficial in 48 (25.1%) and invasive in 43 (22.5%). Invasi ve progression was associated with significantly higher cause specific mort ality than superficial progression (p = 0). In the latter cases cause speci fic mortality was higher than in those without progression (p = 0.001). Alt hough cystectomy significantly decreased the cause specific mortality rate in patients with invasive progression (p = 0.0001), this rate was high at 4 6.3%. Univariate and multivariate analyses revealed that the 3-month clinic al response was a significant predictive factor for progression. Moreover, stratifying this variable showed that this response was the only independen t factor predictive of invasive progression in cases of no response with st age T1 grade 3 tumor, bladder carcinoma in situ, or prostate mucosa or duct involvement (p = 0). In our series 41 patients (21.5%) did not respond aft er intravesical therapy at the 3-month evaluation, including 29 with stage T1 grade 3 disease, bladder carcinoma in situ, or prostate mucosa or duct i nvolvement. Progression in 24 of these 29 patients (82.3%) was classified a s invasive in 21 (73.6%). Conclusions: Invasive progression threatens the cause specific survival of patients with high risk superficial bladder cancer even when cystectomy is performed. The 3-month clinical response was an excellent predictive factor for invasive progression. Early cystectomy should be considered when stage T1 grade 3 tumor, bladder carcinoma in situ, or prostate mucosa or duct in volvement is present at the 3-month clinical evaluation.