The Influence of High-Grade and Low-Grade Histological Sub-Classification of G2 pT1 Transitional Cell Cancer of Bladder on Tumour Recurrence and Progression Rates—5-Year Retrospective Analysis

Abstract

Aim: We assess the impact of the histological sub-classification of newly diagnosed G2 pT1 TCC bladder into low-grade and high-grade groups on the pattern of disease recurrence and progression. Method: A retrospective case note analysis of all newly diagnosed G2 pT1 TCC bladder between January 2003 and December 2007 was performed. The pattern of disease recurrence and progression was recorded and correlated with the histological grade of the original tumour. In addition, the use of adjuvant intravesical chemotherapy or immunotherapy was recorded and the effect of these agents noted. Results: 101 patients were included in the study of which 75 had high-grade disease, 14 had focally high-grade disease and 11 had low-grade disease. The recurrence rate was 42% in the high-grade group and 25% in the low-grade group. The progression rate was 13% in the high-grade group and no progression was seen in the low-grade group. Those patients with high-grade disease receiving adjuvant intravesical BCG (Bacillus Calmette-Guerin) immunotherapy had a progression rate of 6%, whereas those not receiving BCG treatment had a 18% progression rate. Conclusions: This study supports the view that the presence of high-grade elements in G2 pT1 TCC bladder makes it more likely to progress and therefore this group of patients should be treated aggressively, perhaps in a similar fashion to G3 pT1 TCC bladder.