Micropapillary bladder cancer (MPBC) is a rare type of uroepithelial carcinoma (UC). For stage cT1 MPBC that invades the lamina propria, many urologists recommend treatment with radical cystectomy, however some reports suggest that conventional intravesical instillation of BCG is also effective for this disease.
Recent experience with the treatment of stage cT1 micropapillary bladder cancer was recently reported in The Journal of Urology by Willis et al. at the University of Texas, noting that patients who underwent radical cystectomy early benefited more than those who underwent conventional BCG instillation.
The study included 72 patients with micropapillary bladder cancer from 1990 to 2012 at The University of Texas M. D. Anderson Cancer Center who had a pathologic stage of cT1N0M0 after transurethral resection. 40 of these patients were treated with perfusion and 26 with early radical resection, with a median follow-up of 55.5 months. Less than 25% of the entire tumor in the micropapillary region was referred to as a focal lesion.
The results showed a higher rate of tumor recurrence and progression in patients who received early BCG perfusion, 75% and 45%, respectively, with 35% of them developing lymph node metastases. Compared with patients with focal MPBC, patients with extensive MPBC were more likely to experience disease progression during BCG perfusion.
In contrast, only 27% of patients who underwent early radical resection were found to have elevated pathologic stages, and 20% of these patients developed lymph node metastases. These patients also had better survival, with a 5-year specific survival rate (DSS) of 100% compared to 60% for patients with BCG infusion and 62% for patients who had recurrence followed by radical resection. Those patients who developed disease progression without early radical resection had the worst prognosis, with a 5-year specific survival rate of only 24% and a median survival time of 35 months.
The poor outcome of BCG perfusion may be related to several reasons: first, the relatively high rate of lymph node metastasis (35%) in the perfusion group, which suggests that stage cT1 micropapillary bladder cancer is more aggressive than the general stage cT1 uroepithelial cancer; second, micropapillary bladder cancer is more aggressive than the general stage cT1 uroepithelial cancer. higher; secondly, micropapillary bladder cancer itself would make the pathological stage escalated. Thirdly, there may be unknown factors that make BCG ineffective in micropapillary bladder cancer, but the exact mechanisms need to be further investigated.
In conclusion, some patients with stage T1 micropapillary bladder cancer may benefit from BCG intravesical perfusion, but those who undergo radical cystectomy early survive better. The outcome of patients who underwent early trials of BCG intravesical instillation followed by radical resection after disease recurrence and especially progression is not promising. Therefore, radical cystectomy is the recommended treatment for stage cT1 micropapillary bladder cancer, and further research is needed on how to take conservative treatment.
Micropapillary bladder cancer (MPBC) is a rare type of uroepithelial carcinoma (UC). For stage cT1 MPBC that invades the lamina propria, many urologists recommend radical cystectomy, however some reports suggest that conventional intravesical instillation of BCG is also effective for this disease.
Recent experience with the treatment of stage cT1 micropapillary bladder cancer was recently reported in The Journal of Urology by Willis et al. at the University of Texas, noting that patients who underwent radical cystectomy early benefited more than those who underwent conventional BCG instillation.
The study included 72 patients with micropapillary bladder cancer at The University of Texas M. D. Anderson Cancer Center from 1990 to 2012 who had a pathologic stage of cT1N0M0 after transurethral resection. 40 of these patients received perfusion and 26 received early radical resection, with a median follow-up time of 55.5 months. Less than 25% of the entire tumor in the micropapillary region was referred to as a focal lesion.
The results showed a higher rate of tumor recurrence and progression in patients who received early BCG perfusion, 75% and 45%, respectively, with 35% of them developing lymph node metastases. Compared with patients with focal MPBC, patients with extensive MPBC were more likely to experience disease progression during BCG perfusion.
In contrast, only 27% of patients who underwent early radical resection were found to have elevated pathologic stages, and 20% of these patients developed lymph node metastases. These patients also had better survival, with a 5-year specific survival rate (DSS) of 100% compared to 60% for patients with BCG infusion and 62% for patients who had recurrence followed by radical resection. Those patients who developed disease progression without early radical resection had the worst prognosis, with a 5-year specific survival rate of only 24% and a median survival time of 35 months.
The poor outcome of BCG perfusion may be related to several reasons: first, the relatively high rate of lymph node metastasis (35%) in the perfusion group, which suggests that stage cT1 micropapillary bladder cancer is more aggressive than the general stage cT1 uroepithelial cancer; second, micropapillary bladder cancer is more aggressive than the general stage cT1 uroepithelial cancer. higher; secondly, micropapillary bladder cancer itself would make the pathological stage escalated. Thirdly, there may be unknown factors that make BCG ineffective in micropapillary bladder cancer, but the exact mechanisms need to be further investigated.
In conclusion, some patients with stage T1 micropapillary bladder cancer may benefit from BCG intravesical perfusion, but those who undergo radical cystectomy early survive better. The outcome of patients who underwent early trials of BCG intravesical instillation followed by radical resection after disease recurrence and especially progression is not promising. Therefore, radical cystectomy is the recommended treatment for stage cT1 micropapillary bladder cancer, and further research is needed on how to take conservative treatment.