[Surveillance and prognosis of "T1" superficial tumors of the bladder. Homogeneous series of 88 cases followed for 1 to 22 years]

Abstract

Objective: Define the prognostic factors (risk of recurrence and risk of progression) and the rules for surveillance of stage T1 papillary bladder tumours based on the clinical course of a homogeneous patient series.

Material and method: 88 T1 bladder tumours recruited from 1975 to 1995 and regularly followed by the same urologist. The follow-up ranged from 1 to 22 years with a mean of 52 months and a median of 48 months.

Results: 26% patients relapsed (mean follow-up: 71 months) 74% developed one or more recurrences (mean follow-up: 48 months) with recurrences staged > T1 in 35% of cases. 29/88 patients died from invasive bladder cancer, 14 before 3 years, 19 before 5 years, 28 before 10 years. The risk of recurrence and progression was statistically significantly related to the macroscopic appearance of the tumour; size, number and extent of implantations; its rate of progression assessed by the frequency of recurrence. In patients with no recurrence at 12 months, the risk of recurrence decreased from 74% to 50% and the risk of progression decreased from 35% to 20%. In this cohort, neither histological grading of the initial tumour, nor the degree of invasion of the submucosal lamina propria appeared to modify the prognosis.

Conclusion: Stage T1 papillary bladder tumours, generally considered to be a superficial tumours regardless of their histological grade, have a serious prognosis and warrant close endoscopic surveillance during the year following the diagnosis. The subsequent frequency of follow-up can then be adapted to the specific mode of progression of each case, but, regardless of this mode of progression, the authors recommend long-term (life-long?) surveillance.