SUPERFICIAL BLADDER

CANCER; THE PROBLEM OF

T1G3

TUMORS, EGYPTIAN

EXPERIENCE

M. Youssef , T. El-Baradie, F. Fouad .

12/27/2013 1FOUAD[NCI]

INTRODUCTION

• Superficial Bladder Cancer represents 70 to 80% of newly diagnosed bladder cancer cases.

• The combination of T1 with G3 represent a 10% of the superficial cancers.

• Most genitourinary oncologists would agree that T1 G3 superficial bladder cancers are:

• A watershed for therapeutic interventions.

• The ideal treatment remains controversial.

12/27/2013 2FOUAD[NCI]

Aim of The Study

• Our study aimed at reviewing a random

sample of the cases with superficial bladder

cancer that presented to the national cancer

institute – Cairo University within the last

five years in a retrospective way.

• We try to adopt a standard treatment for

this controversial group.

12/27/2013 3FOUAD[NCI]

MATERIAL AND METHODS

• One hundred patients with superficial

bladder cancer were included in this study.

• The patients were randomly sampled from

800 .

• The data at last follow-up was obtained

from the patients’ records as well as by

analysis of the preceding disease history,

radiological investigations and pathology

reports.

12/27/2013 4FOUAD[NCI]

RESULTS

• In this group there were 22 cases with

T1G3 tumors, accounting for 22% of all

the study cases and 35.5% of all the T1

cases.

• Out of 22 patients who were primarily

diagnosed with T1G3 tumors on their first

cystoscopies, 19 patients (86.4%) showed

recurrences within the first 6 months after

cystoscopy and transuretheral resection (TUR)

and intravesical BCG therapy.

12/27/2013 FOUAD[NCI] 5

Frequency of different grades

within the T stages of Primary

Tumors (Tis as a special entity represented 8%)

Stage Frequency

TaG1 19%

TaG2 8%

TaG3 3%

T1G1 6%

T1G2 34%

T1G3 22%

12/27/2013 6FOUAD[NCI]

Frequency of different grades

within the T stages in Subsequent

Recurrences

TaG1 6 (12%)

TaG2 3 (6%)

TaG3 1 (2%)

T1G1 2 (4%)

T1G2 12 (24%)

T1G3 13 (26%)

12/27/2013 7FOUAD[NCI]

Grade of primary tumor vs. Grade of

First Recurrence (Rho value= .849

Grade of Primary Tumor

G1 G2 G3

Grade of

First

Recurrence

G111

(64.7%)2 (5.4%) 0 (0%)

G2 6 (35.3%)32

(86.5%)1 (4, 8%)

G3 0 (0%) 3 (8.1%)20

(95.2%)

12/27/2013 8FOUAD[NCI]

Grade of Primary tumor vs.

Grade of First Recurrence

64.7%

35.3%

0.0%5.4%

86.5%

8.1%0.0%

4.8%

95.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Gra

de

of

1st

recu

rren

ce

G1 G2 G3

Grade

G1 G2 G3

12/27/2013 9FOUAD[NCI]

Grade of Primary Tumor vs. Grade of

Subsequent Recurrence

Grade of Primary Tumor

G1 G2 G3

Grade of

Subsequent

Recurrences

G1 6 (60%) 3 (12.5%) 0 (0%)

G2 4 (40%) 18 (75%) 0 (0%)

G3 0 (0%) 3 (12.5%) 15 (100%)

12/27/2013 10FOUAD[NCI]

Grade of Primary Tumor vs. Grade

of Subsequent Recurrences

60.0%

40.0%

0.0%

12.5%

75.0%

12.5%0.0%

0.0%

100.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Gra

de

of

sub

seq

uen

t re

c.

G1 G2 G3

Grade

G1 G2 G3

12/27/2013 11FOUAD[NCI]

Grade of First Recurrence vs. Grade

of Subsequent Recurrences

Grade of First Recurrence

G1 G2 G3

Grade of

Subseque

nt

Recurren

ces

G18

(88.9%)1 (4.3%) 0 (0%)

G2 1 (11.1%)21

(91.3%)0 (0%)

G3 0 (0%) 1 (4.3%) 17 (100%)

12/27/2013 12FOUAD[NCI]

T Stage of Primary Tumor vs. T

Stage of Subsequent Recurrences(Rho value= .718)

T Stage of Primary Tumor

T1 Ta Tis

T Stage of

Subsequent

Recurrences

T128

(93.3%)6 (40%) 0 (0%)

Ta 2 (6.7%)8

(53.3%)0 (0%)

Tis 0 (0%)1 (6.7

%|)4 (100%)

12/27/2013 13FOUAD[NCI]

T Stage of primary Tumor vs. T Stage

of Subsequent Recurrences

93.3%

6.7%

0.0%

40.0%

53.3%

6.7%

0.0%

0.0%

100.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sta

ge o

f sub

sequ

ent r

ec.

T1 Ta Tis

Stage

T1 Ta Tis

12/27/2013 14FOUAD[NCI]

Number of Recurrences

Correlated to the Grade

Median number of

Recurrences

SD Minim

um

Maxi

mum

G1 2 1.9 1 8

G2 2 1.5 1 7

G3 3 1.3 1 5

12/27/2013 FOUAD[NCI] 15

Time to Recurrence Correlated

to the Grade (P value= .0194)

Median Time to First Recurrence

G1 12 months

G2 6 months

G3 6 months

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Time to Recurrence correlated

to the Grade (P value= .0194)

12/27/2013 FOUAD[NCI] 17

0 12 24 36 48 60 72 84 96

Time to 1st superficial Recurrence (months)

0.0

0.2

0.4

0.6

0.8

1.0

Cum

Sur

viva

l Pro

porti

on

Grade

G1

G2

G3

G1-censored

G2-censored

G3-censored

Invasion-free Survival at 12

months according to the Grade (P value= .004)

12/27/2013 FOUAD[NCI] 18

Invasion-free survival at 12

months

G1 88.0%

G2 85.0%

G3 63.0%

Time to Invasion correlated to

the Grade

12/27/2013 FOUAD[NCI] 19

0 12 24 36 48 60 72 84 96 108 120

Time to Invasion (months)

0.0

0.2

0.4

0.6

0.8

1.0

Cum

Sur

viva

l Pro

port

ion

Grade

G1

G2

G3

G1-censored

G2-censored

G3-censored

Invasion-free Survival at 12

months according to the T

Stage (P value= .004)

Invasion-free survival at 12 months

T1 84.0%

Ta 92.0%

Tis 100.0%

12/27/2013 FOUAD[NCI] 20

Time to Invasion correlated to

the T Stage

12/27/2013 FOUAD[NCI] 21

0 12 24 36 48 60 72 84 96 108 120

Time to Invasion (months)

0.0

0.2

0.4

0.6

0.8

1.0

Cum

Sur

viva

l Pro

port

ion

T Stage

T1

Ta

Tis

T1-censored

Ta-censored

Tis-censored

• The tumors progressed to the muscle

invasive type within a time interval ranging

between 2 months and 3 years. (26 cases

in the study progressed to the muscle

invasive type; the T1G3 type represented

half of them).

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CONCLUSION

• Superficial Bladder Cancer is a group of

heterogeneous disease with a wide range

of biological behaviors.

• T1G3 tumors showed a high rate of progression

and sometimes they invaded very rapidly,

leading to high mortality rates from what was

originally described as “superficial” tumors,

thus justifying the adoption of a new policy for

early radical cystectomy in T1G3 tumors.

12/27/2013 FOUAD[NCI] 23

CONCLUSION

• The adjuvant therapy is a tool that still

needs to be used in the management of

superficial bladder cancer.

• A clear follow-up protocol needs to be set

for this group of patients whose cure mostly

depends on meticulous and close follow-up

12/27/2013 FOUAD[NCI] 24

CONCLUSION

• Clear indications for intravesical

adjuvant therapy application, and of

course accepted indications for early

surgical intervention in the form of

radical cystectomy.

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