Prognostic Factors in Stage T1 Bladder Cancer: Tumor Pattern (Solid or Papillary) and Vascular Invasion More Important than Depth of Invasion

Objectives: We studied the prognostic factors for progression and disease-specific survival in patients with Stage T1 bladder cancer to identify subgroups with different prognoses. Methods: All 121 patients with Stage T1 bladder cancer at first diagnosis in 1987 to 1988 in a large region were prospectively registered. The histopathologic material and the clinical records were reviewed. We performed univariate and multivariate analyses of the clinical and pathologic factors of potential significance for the time to progression and disease-specific survival. At the end of the study, only 18 patients (15%) were alive and had been followed up for a median of 15 years. Results: On univariate analysis, vascular invasion, solid tumor pattern, deep invasion, grade 3 disease, and carcinoma in situ were associated with an increased risk of progression. The multivariate analysis showed that only vascular invasion and tumor pattern had independent prognostic value for progression. Vascular invasion and a solid tumor pattern also had independent prognostic value for disease-specific survival. Conclusions: Patients who have Stage T1 bladder cancer with a solid tumor pattern and/or vascular invasion have a very poor prognosis when treated with transurethral resection only. It is unknown whether intravesical bacille Calmette-Guérin treatment can improve the poor prognosis in such cases.