The treated natural history of high risk superficial bladder cancer: 15-year outcome
MS Cookson, HW Herr, ZF Zhang, S Soloway… - The Journal of …, 1997 - auajournals.org
MS Cookson, HW Herr, ZF Zhang, S Soloway, PC Sogani, WR Fair
The Journal of urology, 1997•auajournals.orgPurpose: The long-term outcome of patients with high risk superficial bladder cancer is
unknown. We report the results of 15 years of followup of high risk patients treated initially
with aggressive local therapy, including transurethral resection alone or combined with
intravesical bacillus Calmette-Guerin. Materials and Methods: Between 1978 and 1981, 86
high risk patients enrolled in a randomized study of transurethral resection alone or with
intravesical bacillus Calmette-Guerin for superficial bladder cancer. Of these patients 81 …
unknown. We report the results of 15 years of followup of high risk patients treated initially
with aggressive local therapy, including transurethral resection alone or combined with
intravesical bacillus Calmette-Guerin. Materials and Methods: Between 1978 and 1981, 86
high risk patients enrolled in a randomized study of transurethral resection alone or with
intravesical bacillus Calmette-Guerin for superficial bladder cancer. Of these patients 81 …
Purpose
The long-term outcome of patients with high risk superficial bladder cancer is unknown. We report the results of 15 years of followup of high risk patients treated initially with aggressive local therapy, including transurethral resection alone or combined with intravesical bacillus Calmette-Guerin.
Materials and Methods
Between 1978 and 1981, 86 high risk patients enrolled in a randomized study of transurethral resection alone or with intravesical bacillus Calmette-Guerin for superficial bladder cancer. Of these patients 81% had diffuse carcinoma in situ and 44% had stage T1 tumors before entry into the study. Patients were followed until death (61%) or until the present time (median followup 184 months).
Results
Disease stage progressed in 46 patients (53%) and 31 (36%) eventually underwent cystectomy for progression reference 28 or refractory carcinoma in situ reference 3, while 18 (21%) had upper tract tumors at a median of 7.3 years. The 10 and 15-year disease specific survival rates were 70 and 63%, respectively. At 15 years 34% of patients overall were dead of bladder cancer, 27% were dead of other causes and 37% were alive, including 27% with an intact functioning bladder.
Conclusions
Despite aggressive local therapy patients with high risk superficial bladder cancer are at lifelong risk for development of stage progression and upper tract tumors. A third of patients are at risk for death from bladder cancer, justifying careful and vigilant long-term followup. These results support the use of initial aggressive local therapy in patients with high risk superficial bladder cancer.
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