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Objective: High-grade T1 bladder urothelial carcinoma (HGT1)has a high risk of recurrence and progression. Optimum management is debatable. We aim to study its progression and management.
Material and methods: Five years retrospective review for all HGT1diagnosed by transurethral resection of bladder tumour (TURBT). Patient and tumour characters were studied. Follow-up intervals and time to recurrence were calculated. Cystectomies either early or late (Defer) were analysed. A routine Statistical analysis was used.
Result: Thirty-nine patients were diagnosed. The average age was 65.6 years and Male to female ratio, 12:1. Group 1 (Gr1) with multi-focal or large tumours were found in 92%while 8% had single smaller tumours in group 2 (Gr2). CIS was found in 10%. A second look revealed residual disease in 38%. Early radical Cystectomy was done in 18%, All in Gr1. The rest were treated with intravesical therapy. Average follow-up was 60 months (36-84).Among them:22% continued on maintenance BCG without recurrence. The rest 78%developed recurrence in time ranged from 3-29 months. Deferred radical Cystectomy with Orthotopic Neobladder was done in 22% for progression. No progression was seen in 56% and underwent a second maintenance BCG. Failure was seen in38% with further recurrence or progression. All underwent defer radical Cystectomy. The remaining 19% continued on maintenance BCG without any recurrence. Overall 5-year survival was 86% and 63%, for early and deferred cystectomy respectively.
Conclusion: Most patients have the significant risk of progression. A radical cystectomy is a strong option at the earliest opportunity.
