Prognostic factors in T1 high-grade urothelial carcinoma of the bladder with lymphovascular invasion: a retrospective cohort study

PurposeTo evaluate the long-term treatment outcomes of T1 high-grade (T1HG) urothelial carcinoma (UCB) with lymphovascular invasion (LVI).MethodsWe retrospectively analyzed the data of 70 patients of T1HG UCB with LVI who were treated at the Second Hospital of Tianjin Medical University between 2009 and 2019. The log rank test and Cox regression analyses were performed to identify factors that predict the recurrence and survival of these "highest risk" group of non-muscle invasive bladder cancer (NMIBC).ResultsWith a median follow-up of 46.0 months (range 2-151), the 5-year overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS) and progression-free survival (PFS) rates were 65%, 78%, 28% and 56% after trans-urethral resection of bladder tumor (TURBT), and 35%, 48%, 35% and 35% after radical cystectomy (RC), respectively. Treatment modality (tumor burden) was and independent predictor of OS (Hazard ratios (HRs) 2.176, 95% confidence intervals (CIs) 1.021-4.637, p = 0.044) and CSS (HRs 3.675, CIs 1.311-10.297, p = 0.013), and was weakly associated with RFS (HRs 0.560, CIs 0.281-1.114, p = 0.099). A history of urothelial carcinoma of the bladder (H.UCB) was an independent predictor of RFS (HRs 2.246, CIs 1.102-4.579, p = 0.026) and PFS (HRs 2.259, CIs 1.036-4.927, p = 0.041). Tumor size was an independent predictor of RFS (HRs 2.093, CIs 1.054-4.159, p = 0.035).ConclusionsIn T1HG UCB with LVI, tumor burden was a significant predictor of survival. Radical cystectomy should be individualized and not universally recommended. Recurrent T1HG UCB with LVI potentially represents a sign of progression, and RC regardless of tumor burden might be a reasonable alternative for this subgroup of patients.