T1G3 bladder carcinoma: Can we still judge them as superficial tumours?

Abstract

— T1G3 bladder carcinomas are classified as superficial tumours and treatment results are included in low stage tumour groups. A review of survival rates shows that there is a high risk of progression, about 50–78%. Among other things this is due to some commonly-accepted factors. The grade is by now considered the most significant prognostic factor. It is easy in this stage for clinical understaging to occur and cases of N + are to be found in all early cystectomies. Another important factor is the differing interpretations by pathologists of the pT category and grade. With conservative treatment there is a progression of 50% after radiotherapy, 40% after endoscopic surgery and 40% after cytotoxic chemotherapy. Better results with BCG immunotherapy are reported with 10–19% progression; however, there is no significant follow-up yet in these cases and they often refer to all superficial tumours including T1G3 which taken singly have clearly worse percentages of recurrence and progression. Best survival rates are achieved with early cystectomy (76–95% at 5 years). These data advise considering T1G3 carcinomas clinically like invasive tumours and early cystectomy as the best therapy, while the risks of delaying cystectomy should be fully assessed.