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High-Grade Non-Muscle Invasive Bladder Cancer: When to Move to Early Radical Cystectomy?

Raed A Azhar1, Anmar M Nassir2, Hesham Saada3

  • 1Department of Urology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU.

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|December 20, 2021
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Summary
This summary is machine-generated.

Early radical cystectomy (RC) may improve cancer-specific survival and reduce complications for select high-grade non-muscle invasive bladder cancer patients compared to deferred RC.

Keywords:
bladder cancernonmuscle invasiveradical cystectomysurvivaltransurethral resectionurothelial malignancy

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Area of Science:

  • Urology
  • Oncology

Background:

  • High-grade non-muscle invasive bladder cancer (HGT1 BC) presents treatment challenges.
  • Balancing bladder preservation with radical cystectomy (RC) is crucial for patient outcomes.

Purpose of the Study:

  • To compare bladder preservation therapy outcomes with early versus deferred radical cystectomy (RC) in HGT1 BC patients.
  • To evaluate cancer-specific survival (CSS) and postoperative complications associated with different treatment strategies.

Main Methods:

  • Prospective data from 71 HGT1 BC patients undergoing transurethral resection of bladder tumor (TURBT) were analyzed.
  • Patients were categorized into conservative therapy (GI), early RC (GII), or deferred RC (GIII) groups.
  • Kaplan-Meier analysis assessed CSS; complications and time to RC were compared.

Main Results:

  • Early RC (GII) patients had fewer repeat TURBTs and a shorter time to RC than deferred RC (GIII) patients.
  • Postoperative complications were significantly higher in the deferred RC group (GIII).
  • Five-year CSS was 79% for GII vs. 75% for GIII; 10-year CSS was 78% for GII vs. 64% for GIII.

Conclusions:

  • Early RC is a viable alternative for selected HGT1 BC patients with longer life expectancy.
  • Early RC may decrease complications and improve CSS.
  • Selection bias in this retrospective study warrants consideration.