Objectives: This retrospective study evaluates the outcome of patients with T1G3 bladder cancer treated by transurethral resection (TUR) and intravesical doxorubicin prophylaxis and identifies clinically useful prognostic factors.
Methods: One hundred twenty-eight consecutive patients with primary T1G3 bladder cancer were treated by TUR followed by 1-year intravesical prophylaxis with doxorubicin. Sex, age, number, size, and morphology of the tumors, exfoliative cytology, presence of dysplasia at first observation, pathologic findings of the first recurrence, and number of recurrences were the parameters considered in a multivariate analysis whose object was to identify specific risk factors for recurrence and progression.
Results: The recurrence rate was 56.3% and progression of disease was seen in 23.4% of cases with a disease-specific mortality rate of 7.8%. The disease-free survival in patients who had cystectomy was 37.7 months and the disease-specific mortality rate for this group was 35.7%. The recurrence rate was found to be significantly higher for multiple tumors, solid morphology, size greater than 3 cm, positive exfoliative cytology, and concurrent dysplasia. The reappearance of Stage 1, grade 3 tumor on first recurrence was the only factor found to be correlated with progression.
Conclusions: Up front therapy consisting of TUR and intravesical doxorubicin prophylaxis is appropriate for T1G3 bladder cancer. Patients with unfavorable prognostic factors should be kept under strict control; and if a T1G3 tumor is identified on first recurrence, immediate cystectomy should be considered.