T1-bladder carcinoma: Indication for transurethral electroresection or primary radical cystectomy

The therapy guidelines for T1-urothelial carcinomas of the urinary bladder are not uniform. In a retrospective analysis, the clinical data of 88 patients with T1-bladder carcinoma treated only with TUR were compared to the data of 45 patients with radical cystectomy for T1-bladder carcinoma. The mean follow-up was 54 +/- 39 (12-144) months in the TUR group and 34 +/- 22 (12-96) months in the cystectomy group. The risk profile of both groups was similar. In the TUR group, 73.9% of the tumors recurred, the progression rate was 37.5%, and the total mortality rate 29.5%. In the cystectomy group, the total mortality of 13% was significantly lower (p=0.0392) than in the TUR group. The mortality rates of patients with T1 G2 (p=0.0286) and primary T1-tumors (p=0.0017) were significantly lower following cystectomy than following TUR. Local recurrences or operative mortality did not occur in the cystectomy group. In conclusion we recommend TUR with recurrence prophylaxis for T1 G1 and primary unilocular T1 G2 carcinomas. For multilocular or recurrent T1 G2 and for all T1 G3 carcinomas, radical cystectomy should be performed.