Division of Urology, Department of Surgery, University of Toronto, University Health Network, Toronto, Canada.
Eur Urol. 2010 Jan;57(1):60-70. doi: 10.1016/j.eururo.2009.08.024. Epub 2009 Sep 1.
High-grade T1 (formerly T1G3) bladder cancer (BCa) has a high propensity to recur and progress. As a result, decisions pertaining to its treatment are difficult. Treatment with bacillus Calmette-Guérin (BCG) risks progression and metastases but may preserve the bladder. Cystectomy may offer the best opportunity for cure but is associated with morbidity and a risk of mortality, and it may constitute potential overtreatment for many cases of T1G3 tumours. For purposes of this review, we continue to refer to high-grade T1 lesions as "T1G3."
To review the current literature on the management of T1G3 BCa and to provide recommendations for its treatment.
A National Center for Biotechnology Information (NCBI) PubMed search for relevant articles published between 1996 and 9 January 2009 was performed using the Medical Subject Headings "T1G3" or "T1" and "Bladder cancer." Articles relevant to the treatment of T1G3 BCa were retained.
The diagnosis of T1G3 disease is difficult because pathologic staging is often unreliable and because of the risk of significant understaging at initial transurethral resection (TUR) of bladder tumour. A secondary restaging TUR is recommended for all cases of T1G3. A single dose of immediate post-TUR chemotherapy is recommended. For a bladder-sparing approach, intravesical BCG should be given as induction with maintenance dosing. Immediate or early radical cystectomy (RC) should be offered to all patients with recurrent or multifocal T1G3 disease, those who are at high risk of progression, and those failing BCG treatment.
Both bladder preservation and RC are appropriate options for T1G3 BCa. Risk stratification of patients based on pathologic features at initial TUR or at recurrence can select those most appropriate for bladder preservation compared to those for whom cystectomy should be strongly considered.
高级 T1（以前称为 T1G3）膀胱癌（BCa）有很高的复发和进展倾向。因此，其治疗决策非常困难。卡介苗（BCG）治疗有进展和转移的风险，但可能保留膀胱。膀胱切除术可能提供最好的治愈机会，但与发病率和死亡率相关，并且对于许多 T1G3 肿瘤病例，可能构成潜在的过度治疗。出于本综述的目的，我们继续将高级 T1 病变称为“T1G3”。
回顾 T1G3 BCa 治疗的现有文献，并为其治疗提供建议。
使用“T1G3”或“T1”和“膀胱癌”的医学主题词，在国家生物技术信息中心（NCBI）PubMed 上进行了 1996 年至 2009 年 1 月 9 日期间发表的相关文章的检索。保留与 T1G3 BCa 治疗相关的文章。
T1G3 疾病的诊断困难，因为病理分期常常不可靠，并且由于初始经尿道膀胱肿瘤切除术（TUR）时存在显著分期不足的风险。建议对所有 T1G3 病例进行二次分期 TUR。推荐对所有 T1G3 患者进行 TUR 后即刻单次剂量化疗。为了保留膀胱，应给予膀胱内 BCG 诱导维持剂量。对于复发性或多灶性 T1G3 疾病、进展风险高或 BCG 治疗失败的患者，应立即或早期行根治性膀胱切除术（RC）。
膀胱保留和 RC 都是 T1G3 BCa 的合适选择。基于初始 TUR 或复发时的病理特征对患者进行风险分层，可以选择那些最适合膀胱保留的患者，而不是那些强烈考虑行膀胱切除术的患者。
