Tumor progression and survival in patients with T1G3 bladder tumors: Multicentric retrospective study comparing 94 patients treated during 17 years

Objectives. To compare tumor recurrence, progression, and patient survival in T1G3 bladder tumors treated with transurethral resection (TUR) alone, ea rly cystectomy, or TUR with an adjuvant 6-week course of bacille Calmette-G uerin (BCG) and followed up for a minimum of 5 years. Methods. Between 1979 and 1996, 94 patients with T1G3 bladder tumors (lamin a propria invasion) were treated at nine different centers. The time to tum or recurrence, tumor stage and grade progression, number of delayed cystect omies, and patient survival were analyzed retrospectively in relation to th e initial treatment. Results. The mean follow-up was 62 months. Thirty patients were treated by TUR alone (32%), 50 patients by TUR plus BCG (53%), and 14 patients by prim ary cystectomy (15%). The recurrence, progression, and cystectomy rates wer e significantly different between patients treated by TUR alone and TUR plu s BCG (Fisher's exact test, P = 0.0005, P = 0.02, and P = 0.005, respective ly). The disease-free survival was also significantly different when compar ing TUR plus BCG with TUR alone or primary cystectomy (Kaplan-Meier analysi s, log-rank test, P = 0.02). Conclusions. Endoscopic resection plus BCG treatment of pT1G3 tumors allows an 80% rate of disease-free 5-year survival with bladder preservation. Thi s conservative option has been widely accepted as first-line treatment, off ering good cancer control with excellent quality of life. Very accurate sur gical and pathologic evaluations before treatment and lifelong follow-up ar e obviously required. (C) 2001, Elsevier Science Inc.