Literature lacks clear evidence regarding the optimal treatment for non-muscle-invasive micropapillary bladder cancer (MPBC) due to its rarity and the presence of only small sample size and single-centre studies.
To assess cancer-specific mortality (CSM) and overall mortality (OM) between immediate radical cystectomy (RC) and conservative management among T1 high-grade (HG) MPBC.
We retrospectively analysed a multicentre dataset including 119 T1 HG MPBC patients treated between 2005 and 2019 at 15 tertiary referral centres. The median follow-up time was 35 mo (interquartile range: 19-64).
Patients underwent immediate RC versus conservative management with bacillus Calmette-Guérin.
Cumulative incidence functions and Kaplan-Meier methods were applied to estimate survival outcomes. Multivariable Cox analyses were performed to assess independent predictors of disease recurrence and disease progression after conservative management; covariates consisted of pure MPBC, concomitant lymphovascular invasion (LVI), and carcinoma in situ at initial diagnosis.
Immediate RC and conservative management were performed in 27% and 73% of patients, respectively. CSM and OM did not differ significantly among patient treated with immediate RC versus conservative management (Pepe-Mori test p = 0.5 and log-rank test p = 0.9, respectively). Overall, 66.7% and 34.5% of patients experienced disease recurrence and disease progression after conservative management, respectively. At multivariable Cox analyses, concomitant LVI was an independent predictor of disease recurrence (p = 0.01) and progression (p = 0.03), while pure MPBC was independently associated with disease progression (p = 0.03). The absence of a centralised re-review and the retrospective design represent the main limitations of our study.
Conservative management could achieve satisfactory results among T1 HG MPBC patients with neither pure MPBC nor LVI at initial diagnosis.
Bacillus Calmette-Guérin seems to be an effective therapy for T1 micropapillary bladder cancer patients with neither pure micropapillary disease nor lymphovascular invasion at initial diagnosis.
European urology focus. 2021 Aug 18 [Epub ahead of print]
Chiara Lonati, Philipp Baumeister, Luca Afferi, Andrea Mari, Andrea Minervini, Wojciech Krajewski, Sosan Azizi, Kees Hendricksen, Alberto Martini, Andrea Necchi, Francesco Montorsi, Alberto Briganti, Renzo Colombo, Alessandro Tafuri, Alessandro Antonelli, Maria Angela Cerruto, Morgan Rouprêt, Alexandra Masson-Lecomte, Ekaterina Laukhtina, David D'Andrea, Shahrokh F Shariat, Francesco Soria, Giancarlo Marra, Paolo Gontero, Roberto Contieri, Rodolfo Hurle, Anne Sophie Valiquette, M Carmen Mir, Stefania Zamboni, Claudio Simeone, Tobias Klatte, Jeremy Yuen-Chun Teoh, Soichiro Yoshida, Yasuhisa Fujii, Roberto Carando, Gerald B Schulz, Livio Mordasini, Agostino Mattei, Marco Moschini, European Association of Urology Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group
Department of Urology, Spedali Civili di Brescia, Brescia, Italy; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: ., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland., Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy., Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland., Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Medical Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy., Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy., GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France., APHP, Department of Urology, Hôpital Saint Louis, Université de Paris, Paris, France., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic., Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Torino School of Medicine, Torino, Italy., Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy., Department of Urology, Fundación Instituto Valenciano de Oncologia, Valencia, Spain., Department of Urology, Spedali Civili di Brescia, Brescia, Italy., Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany., Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Tokyo Medical and Dental University Graduate School, Yushima, Bunkyo-ku, Tokyo, Japan., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Clinica Luganese Moncucco, Lugano, Switzerland; Clinica S. Anna, Swiss Medical Group, Sorengo, Switzerland; Clinica Santa Chiara, Locarno, Switzerland., Department of Urology, Ludwig-Maximilians-University, Munich, Germany., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.