The Case for Early Cystectomy in the Treatment of Nonmuscle Invasive Micropapillary Bladder Carcinoma

No AccessJournal of UrologyAdult urology1 Mar 2006The Case for Early Cystectomy in the Treatment of Nonmuscle Invasive Micropapillary Bladder Carcinomais corrected byErrata Ashish M. Kamat, Jason R. Gee, Colin P.N. Dinney, H. Barton Grossman, David A. Swanson, Randall E. Millikan, Michelle A. Detry, Tracy L. Robinson, and Louis L. Pisters Ashish M. KamatAshish M. Kamat Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas , Jason R. GeeJason R. Gee Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas , Colin P.N. DinneyColin P.N. Dinney Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas , H. Barton GrossmanH. Barton Grossman Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas , David A. SwansonDavid A. Swanson Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas , Randall E. MillikanRandall E. Millikan Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas , Michelle A. DetryMichelle A. Detry Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas , Tracy L. RobinsonTracy L. Robinson Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas , and Louis L. PistersLouis L. Pisters Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)00423-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Micropapillary bladder carcinoma is a rare variant of UC. Due to paucity of data regarding treatment outcomes, patients with nonmuscle invasive micropapillary UC often receive intravesical therapy in an attempt at bladder preservation. Materials and Methods: We reviewed the records of all patients evaluated at our institution who had micropapillary UC of the bladder. Of these, 44 had nonmuscle invasive disease at presentation and form the basis of this report. Results: Mean patient age was 64.3 years (range 45 to 81) with a male-to-female ratio of 13:1. Stage distribution at presentation was 5 Ta (11%), 4 CIS (9%) and 35 T1 (80%). Median CSS was 81 months. Kaplan-Meier estimates of 5 and 10-year CSS rates were 64% and 26%, respectively. Intravesical BCG therapy was attempted in 27 patients (61%). Of these 27 patients, 67% (18 of 27) had progression (cT2 or greater), including 22% in whom metastatic disease developed. Only 19% of patients (5 of 27, all T1) remain disease-free with an intact bladder at a median followup of 30 months. A total of 30 patients (68%) underwent cystectomy. Among patients who underwent cystectomy after progression (18), median CSS was 61.7 months with no patient surviving 10 years, whereas among those undergoing cystectomy as initial therapy (12), median survival was not reached and the 10-year CSS rate was 72%. Conclusions: Intravesical BCG therapy appears to be ineffective against micropapillary UC. Our results suggest that the optimal treatment strategy for nonmuscle invasive micropapillary UC is radical cystectomy performed before progression. References 1 : Intravesical therapy for bladder cancer. Urology2000; 55: 161. Google Scholar 2 : Micropapillary variant of transitional cell carcinoma of the urinary bladder. Histologic pattern resembling ovarian papillary serous carcinoma. Am J Surg Pathol1994; 18: 1224. Google Scholar 3 : Micropapillary bladder carcinoma: a clinicopathological study of 20 cases. J Urol1999; 161: 1798. 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Google Scholar © 2006 by American Urological AssociationFiguresReferencesRelatedDetailsCited byGinsburg K, Schober J, Bukavina L, Murray N, Chandra A, Chen D, Greenberg R, Viterbo R, Uzzo R, Smaldone M, Kutikov A and Correa A (2022) Oncologic Outcomes of cT1 and cT2 Micropapillary Variant Compared with cT1 and cT2 Conventional Urothelial Carcinoma Treated with Radical CystectomyUrology Practice, VOL. 9, NO. 5, (396-404), Online publication date: 1-Sep-2022.Hensley P, Bree K, Campbell M, Alhalabi O, Kokorovic A, Miest T, Nogueras-Gonzalez G, Gao J, Siefker-Radtke A, Guo C, Navai N, Dinney C and Kamat A (2021) Progression of Disease after Bacillus Calmette-Guérin Therapy: Refining Patient Selection for Neoadjuvant Chemotherapy before Radical CystectomyJournal of Urology, VOL. 206, NO. 5, (1258-1267), Online publication date: 1-Nov-2021.Willis D, Fernandez M, Dickstein R, Parikh S, Shah J, Pisters L, Guo C, Henderson S, Czerniak B, Grossman H, Dinney C and Kamat A (2014) Clinical Outcomes of cT1 Micropapillary Bladder CancerJournal of Urology, VOL. 193, NO. 4, (1129-1134), Online publication date: 1-Apr-2015.Spaliviero M, Dalbagni G, Bochner B, Poon B, Huang H, Al-Ahmadie H, Donahue T, Taylor J, Meeks J, Sjoberg D, Donat S, Reuter V and Herr H (2014) Clinical Outcome of Patients with T1 Micropapillary Urothelial Carcinoma of the BladderJournal of Urology, VOL. 192, NO. 3, (702-707), Online publication date: 1-Sep-2014.Abd el-Latif A, Watts K, Elson P, Fergany A and Hansel D (2012) The Sensitivity of Initial Transurethral Resection or Biopsy of Bladder Tumor(s) for Detecting Bladder Cancer Variants on Radical CystectomyJournal of Urology, VOL. 189, NO. 4, (1263-1267), Online publication date: 1-Apr-2013.Related articlesJournal of Urology9 Nov 2018Errata Volume 175Issue 3March 2006Page: 881-885 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsadministrationintravesicalbladder neoplasmscystectomytransitional cellcarcinomaBCG vaccineMetricsAuthor Information Ashish M. Kamat Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas Financial interest and/or other relationship with Abbott-Vysis. More articles by this author Jason R. Gee Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas Nothing to disclose. More articles by this author Colin P.N. Dinney Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas Financial interest and/or other relationship with Canji/Schering-Plough, Abbott/Vysis, AstraZeneca, National Cancer Institute and GlaxoSmithKline. More articles by this author H. Barton Grossman Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas Financial interest and/or other relationship with Fujirebio Diagnostics Inc., Photocure, Abbott Molecular, AstraZeneca, Pharmacia and UroCor. More articles by this author David A. Swanson Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas Financial interest and/or other relationship with Kidney Cancer Association, Abbott, Bayer/Onyx and Steba-Biotech. More articles by this author Randall E. Millikan Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas Financial interest and/or other relationship with Eli Lilly & Company and Bristol-Myers Squibb. More articles by this author Michelle A. Detry Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas Nothing to disclose. More articles by this author Tracy L. Robinson Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas Nothing to disclose. More articles by this author Louis L. Pisters Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas Financial interest and/or other relationship with Endocare, American Medical Systems and Abbott Pharmaceuticals. 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