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Figure 1. The typical treatment paradigm of newly diagnosed T1 high-grade bladder cancer. Progression risk indicated as HR between the favorable (favors BCG) and unfavorable (favors cystectomy) variable. BCG: Bacillus Calmette-Guérin; CIS: Carcinoma in situ ; HR: Hazard ratio; LVI: Lymphovascular invasion; PFS: Progression-free survival; pT1: Pathological T1; T1HG: T1 high-grade; TUR: Transurethral resection; TURBT: Transurethral resection of urinary bladder tumor.
(Figure omitted. See article PDF.)
T1 high-grade (T1HG; formerly T1G3) bladder cancer includes a subgroup of bladder cancer cases with an exceptionally variable clinical course and it is one of the most challenging patient groups to manage within the field of uro-oncology. T1HG cancer is the most aggressive tumor type within an entity previously known as 'superficial bladder cancer'and currently labeled as non-muscle-invasive bladder tumors, that is, tumors not invading the detrusor muscle layer of the bladder. As the natural history of superficial bladder cancer has great variation, the terms non-muscle-invasive bladder cancer or TaT1 bladder cancer are indeed recommended instead of the term superficial bladder cancer [1,2].
Approximately 70% of all new bladder cancer cases present as TaT1 cancers, and T1 tumors account for approximately 20% of TaT1 tumors [1]. As the global incidence is approximately 360,000 new bladder cancer cases annually, the estimated annual worldwide incidence of T1HG bladder cancer cases alone is approximately 50,000 patients [101]. Since some of the Ta and carcinoma in situ (CIS) lesions will progress into T1 lesions, the true number of this patient group is even higher. As urothelial cancer accounts for over 90% of all bladder cancers in the Western world, we will exclude nonurothelial cancers from the scope of this article. We will describe the recommended staging processes of T1HG lesions and we will present the current literature of the results of both the conservative approach and radical surgery. We will also discuss prognostic factors and the challenges of patient selection for radical surgery, and the timing of the surgery. Finally, we will discuss future prospects and possible advancements provided by improved surgical techniques.
Staging of T1HG bladder cancer
T1 high-grade bladder cancer is defined as a bladder tumor with aggressive microscopic appearance and invasion to the layer in between the mucosa and detrusor muscle, that is, the lamina propria. High grade refers...