High-grade bladder Ca: New data improve risk stratification
At the Society of Urologic Oncology annual meeting in San Antonio, Joaquim Bellmunt, MD, PhD, highlighted potential means to improve risk stratification in patients with high-grade T1 bladder cancer, a population with highly variable prognosis and poorly understood risk factors.
“We need to identify those patients with high-grade T1 bladder cancer that are likely to recur or progress… and find additional options to prevent recurrence and progression in these patients.” Dr. Bellmunt pointed out during his presentation on targeted approaches for T1 bladder cancer.
In a recent meta-analysis of over 15,000 patients conducted at the Dana-Farber Cancer Institute, Boston, where Dr. Bellmunt is director of the Bladder Cancer Center, investigators identified clinico-pathologic factors associated with poor outcomes (J Clin Oncol 2015; 33:643-50). The authors found that lamina propria invasion into or beyond the muscularis mucosa or vascular plexus (subclassifications T1b/c) had the largest negative impact on the risks of progression and cancer-specific death. Additionally, lymphovascular invasion, associated carcinoma in situ, nonuse of bacillus Calmette–Guérin (BCG), tumor size >3 cm, and older age were also associated with worse outcomes.
The importance of T1 subclassification in predicting disease progression was then prospectively validated in a cohort of 200 patients with high-grade T1 disease (Br J Cancer 2015; 112:468-74).