Use of radical cystectomy as initial therapy for the treatment of high-grade T1 urothelial carcinoma of the bladder: a SEER database analysis.

OBJECTIVES

High-grade T1 (HGT1) bladder cancer represents a heterogeneous disease with an aggressive phenotype. Despite prior reports demonstrating improved cancer-specific mortality (CSM) in patients who receive an early/immediate radical cystectomy (RC), the role of early surgery remains ill-defined. We analyzed the Surveillance Epidemiology and End Results (SEER) database to ascertain the use of RC as an initial therapy for clinical HGT1 bladder cancer.

MATERIALS AND METHODS

Using the SEER database from 2004 through 2007, we identified and stratified patients with clinical HGT1 bladder cancer who underwent RC as initial therapy within 1 year of diagnosis. We used χ(2) tests and t-tests to compare characteristics of surgical vs. nonsurgical patients. Cumulative incidence functions and Gray's test for inferences were employed to assess cause-specific mortality outcomes.

RESULTS

From 2004 to 2007, 8,467 patients were diagnosed with clinical HGT1 bladder cancer, and 397 (4.7%) patients underwent RC. Patients who underwent RC for clinical HGT1 disease were significantly younger (P < 0.0001) and married (P < 0.0001). Surgical patients also had a significantly improved overall (P = 0.004) and other cause of death (P = 0.0053) survival probabilities yet CSM at 1, 2, and 3 years was not statistically different between the surgical and nonsurgical groups (P = 0.134).

CONCLUSIONS

In contrast to the clinically early stage renal and prostate cancers, HGT1 bladder cancer exhibits a higher degree of early progression and potential lethality. Despite routine use of extirpative surgery for T1 lesions of the kidney and prostate, our analysis of the SEER database reveals that definitive surgical therapy is uncommonly employed for HGT1 bladder cancer.