T1 bladder cancer: current considerations for diagnosis and management

Brian Jordan, Joshua J. Meeks*

*Corresponding author for this work

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

Stage T1 bladder cancers invade the lamina propria of the bladder and, despite sharing many of the genetic features of muscle-invasive bladder cancers, are classified as non-muscle-invasive or ‘superficial’ tumours. Yet, patients with T1 bladder cancer have an overall mortality of 33% and a cancer-specific mortality of 14% at three years after diagnosis, suggesting that these patients have a high risk of progression and, accordingly, require meticulous surgery, endoscopic surveillance and clinical decision-making. We hypothesize that the variability in the outcomes of patients with T1 bladder cancer is a result of both tumour heterogeneity and pathological staging, as well as inconsistencies in risk stratification, endoscopic resection and schedules of delivery of BCG. Owing to limitations in clinical staging, patients with T1 bladder cancer are at risk of both undertreatment with persistent use of BCG despite recurrence, and overtreatment with early cystectomy. Understanding the molecular features of T1 bladder cancers and how they respond to BCG therapy could improve biomarkers for risk stratification to align therapy with biological risk.

Original languageEnglish (US)
Pages (from-to)23-34
Number of pages12
JournalNature Reviews Urology
Volume16
Issue number1
DOIs
StatePublished - Jan 1 2019

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Urinary Bladder Neoplasms
Mycobacterium bovis
Neoplasms
Biological Therapy
Mortality
Cystectomy
Appointments and Schedules
Mucous Membrane
Urinary Bladder
Biomarkers
Recurrence
Muscles

ASJC Scopus subject areas

  • Urology

Cite this

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title = "T1 bladder cancer: current considerations for diagnosis and management",
abstract = "Stage T1 bladder cancers invade the lamina propria of the bladder and, despite sharing many of the genetic features of muscle-invasive bladder cancers, are classified as non-muscle-invasive or ‘superficial’ tumours. Yet, patients with T1 bladder cancer have an overall mortality of 33{\%} and a cancer-specific mortality of 14{\%} at three years after diagnosis, suggesting that these patients have a high risk of progression and, accordingly, require meticulous surgery, endoscopic surveillance and clinical decision-making. We hypothesize that the variability in the outcomes of patients with T1 bladder cancer is a result of both tumour heterogeneity and pathological staging, as well as inconsistencies in risk stratification, endoscopic resection and schedules of delivery of BCG. Owing to limitations in clinical staging, patients with T1 bladder cancer are at risk of both undertreatment with persistent use of BCG despite recurrence, and overtreatment with early cystectomy. Understanding the molecular features of T1 bladder cancers and how they respond to BCG therapy could improve biomarkers for risk stratification to align therapy with biological risk.",
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T1 bladder cancer : current considerations for diagnosis and management. / Jordan, Brian; Meeks, Joshua J.

In: Nature Reviews Urology, Vol. 16, No. 1, 01.01.2019, p. 23-34.

Research output: Contribution to journalReview article

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T2 - current considerations for diagnosis and management

AU - Jordan, Brian

AU - Meeks, Joshua J.

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AB - Stage T1 bladder cancers invade the lamina propria of the bladder and, despite sharing many of the genetic features of muscle-invasive bladder cancers, are classified as non-muscle-invasive or ‘superficial’ tumours. Yet, patients with T1 bladder cancer have an overall mortality of 33% and a cancer-specific mortality of 14% at three years after diagnosis, suggesting that these patients have a high risk of progression and, accordingly, require meticulous surgery, endoscopic surveillance and clinical decision-making. We hypothesize that the variability in the outcomes of patients with T1 bladder cancer is a result of both tumour heterogeneity and pathological staging, as well as inconsistencies in risk stratification, endoscopic resection and schedules of delivery of BCG. Owing to limitations in clinical staging, patients with T1 bladder cancer are at risk of both undertreatment with persistent use of BCG despite recurrence, and overtreatment with early cystectomy. Understanding the molecular features of T1 bladder cancers and how they respond to BCG therapy could improve biomarkers for risk stratification to align therapy with biological risk.

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