AccScience Publishing / Bladder / Online First / DOI: 10.14440/bladder.0039
Submit to Bladder
Cite this article
7
Download
171
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
RESEARCH ARTICLE

Real-world management of T1 high-grade bladder cancer: A 14-year retrospective single-center study

Zexuan Lv1,2,3† ,  Yi Feng1,2,4† ,  Bingyang Guo1,2,4† ,  Bin Jiang1,2,3 ,  Hongyu Zhang1,2,3 ,  Yin Lu1,2,3 ,  Wenfeng Gao1,2,3 ,  Jinlu Tang1,2,4 ,  Qing Ai1,2 ,  Qiang Cheng1,2,4* ,  Hongzhao Li1,2*
Show Less
1 Department of Urology, The Third Medical Center, People’s Liberation Army General Hospital, Beijing 100039, China
2 Department of Urology, Chinese People’s Liberation Army General Hospital, Beijing 100039, China
3 School of Medicine, Nankai University, Tianjin 300071, China
4 Chinese People’s Liberation Army Medical School, Beijing 100853, China
Bladder, e21200060 https://doi.org/10.14440/bladder.0039
Submitted: 15 April 2025 | Revised: 9 July 2025 | Accepted: 11 July 2025 | Published: 22 August 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Download PDF
Cite
XML
Abstract

Background: T1 high-grade (T1HG) bladder cancer (BC) carries substantial risks of recurrence and progression, deserving of heightened clinical attention. Objective: The present study evaluated the management approaches and reported 14-year real-world outcomes in patients with T1HG BC from a single-center cohort. Methods: Data were retrospectively collected from primary T1HG patients who had undergone transurethral resection of bladder tumors (TURBT) at our institution between 2010 and 2023. A total of 165 patients were included. Their baseline characteristics, pathological findings, adjuvant therapies, recurrence, progression, and survival outcomes were analyzed. Predictors of tumor recurrence were modeled using multivariable analyses. Results: Tumor recurrence was significantly associated with post-operative Bacillus Calmette–Guérin (BCG) treatment (odds ratio [OR]: 0.315, p=0.001) and tumor multifocality (OR: 0.476, p=0.033). Among patients having received post-operative BCG treatment, tumor recurrence bore a significant correlation with tumor multifocality (OR: 0.328, p=0.027), and elevated body mass index (BMI) was identified as a potential accelerator of recurrence (hazard ratio: 1.098, p=0.01). The 10-year recurrence-free survival rate among all patients stood at 54.9% (95% confidence interval [CI]: 44.3–65.5%), with a median of 134 months (95% CI: 64.7–203.3 months). The rate of re-TURBT was 20%. The 10-year progression-free survival was 87.2% (95% CI: 81.0–93.5%) and the 10-year overall survival was 66.7% (95% CI: 54.0–79.4%). The 10-year cancer-specific survival and the 10-year cystectomy-free survival (CFS) rates were 93.7% (95% CI: 88.4–99.0%) and 86.3% (95% CI: 79.8–92.8%), respectively. Notably, BCG treatment significantly improved CFS (p=0.01). Conclusion: Recurrence in T1HG disease is associated with BCG therapy and tumor multifocality, with a high BMI potentially promoting relapse.

Keywords
Non-muscle invasive bladder cancer
Bladder preservation
Cystectomy
Bacillus Calmette–Guérin treatment
Tumor recurrence
Funding
This work was supported by the National Key R and D Program of China (No. 2023YFC2507006 and No. 2022YFC3602900) and the Central Health Research Project (The project number 2024YB14).
Conflict of interest
The authors declare no conflict of interest.
References
  1. Dyrskjøt L, Hansel DE, Efstathiou JA, et al. Bladder cancer. Nat Rev Dis Primers. 2023;9(1):58. doi: c10.1038/s41572-023-00468-9

 

  1. Dobruch J, Oszczudłowski M. Bladder cancer: Current challenges and future directions. Medicina (Kaunas). 2021;57(8):749. doi: 10.3390/medicina57080749

 

  1. Kim K, Byun YJ, Zheng CM, et al. COL6A1 expression as a potential prognostic biomarker for risk stratification of T1 high grade bladder cancer: Unveiling the aggressive nature of a distinct non-muscle invasive subtype. Investig Clin Urol. 2024;65(1):94-103. doi: 10.4111/icu.20230227

 

  1. Knowles MA, Hurst CD. Molecular biology of bladder cancer: New insights into pathogenesis and clinical diversity. Nat Rev Cancer. 2015;15(1):25-41. doi: 10.1038/nrc3817

 

  1. Soria F, Dutto D, Gontero P. Clinical and biological markers for risk-stratification of T1 high-grade non-muscle invasive bladder cancer. Curr Opin Urol. 2022;32(5):517-522. doi: 10.1097/MOU.0000000000001014

 

  1. Drachneris J, Morkunas M, Fabijonavicius M, Cekauskas A, Jankevicius F, Laurinavicius A. Spatial distribution of macrophage and lymphocyte subtypes within tumor microenvironment to predict recurrence of non-muscle-invasive papillary urothelial carcinoma after BCG immunotherapy. Int J Mol Sci. 2024;25(9):4776. doi: 10.3390/ijms25094776

 

  1. Ferro M, Vartolomei MD, Russo GI, et al. An increased body mass index is associated with a worse prognosis in patients administered BCG immunotherapy for T1 bladder cancer. World J Urol. 2019;37(3):507-514. doi: 10.1007/s00345-018-2397-1

 

  1. Liang Y, Tan Y, Guan B, et al. Single-cell atlases link macrophages and CD8+ T-cell subpopulations to disease progression and immunotherapy response in urothelial carcinoma. Theranostics. 2022;12(18):7745-7759. doi: 10.7150/thno.77281

 

  1. Slovacek H, Zhuo J, Taylor JM. Approaches to non-muscle-invasive bladder cancer. Curr Oncol Rep. 2021;23(9):105. doi: 10.1007/s11912-021-01091-1

 

  1. Woldu SL, Bagrodia A, Lotan Y. Guideline of guidelines: Non-muscle-invasive bladder cancer. BJU Int. 2017;119(3):371-380. doi: 10.1111/bju.13760

 

  1. Klaassen Z, Kamat AM, Kassouf W, et al. Treatment strategy for newly diagnosed T1 high-grade bladder urothelial carcinoma: New insights and updated recommendations. Eur Urol. 2018;74(5):597-608. doi: 10.1016/j.eururo.2018.06.024

 

  1. Yong C, Mott SL, Steinberg RL, Packiam VT, O’Donnell MA. A longitudinal single center analysis of T1HG bladder cancer: An 18 year experience. Urol Oncol. 2022;40(11):491.e1-491.e9. doi: 10.1016/j.urolonc.2022.06.007

 

  1. Nowak Ł, Krajewski W, Moschini M, et al. Assessment of the oncological outcomes of three different Bacillus Calmette- Guérin strains in patients with high-grade T1 non-muscle-invasive bladder cancer. Arab J Urol. 2021;19(1):78-85. doi: 10.1080/2090598X.2021.1874628

 

  1. Piszczek R, Krajewski W, Subiela JD, et al. Prognosis of patients with T1 low-grade urothelial bladder cancer treated with Bacillus calmette-guérin immunotherapy. Minerva Urol Nephrol. 2023;75(5):591-599. doi: 10.23736/S2724-6051.23.05418-6

 

  1. Ślusarczyk A, Garbas K, Zapała P, Zapała Ł, Radziszewski P. Oncological outcomes of high-grade T1 non-muscle-invasive bladder cancer treatment in octogenarians. Int Urol Nephrol. 2021;53(8):1591-1597. doi: 10.1007/s11255-021-02870-2

 

  1. Lee J, Yoo S, Choo MS, Cho MC, Son H, Jeong H. Prognostic role of preoperative neutrophil-to-lymphocyte ratio (NLR) and Recurrence at first evaluation after Bacillus calmette-guérin (BCG) induction in non-muscle-invasive Bladder cancer. Diagnostics (Basel). 2023;13(19):3114. doi: 10.3390/diagnostics13193114

 

  1. Ferro M, Di Lorenzo G, Vartolomei MD, et al. Absolute basophil count is associated with time to recurrence in patients with high-grade T1 bladder cancer receiving Bacillus calmette-guérin after transurethral resection of the bladder tumor. World J Urol. 2020;38(1):143-150. doi: 10.1007/s00345-019-02754-2

 

  1. Kim HS, Ku JH, Kim SJ, et al. Prognostic factors for recurrence and progression in korean non-muscle-invasive bladder cancer patients: A retrospective, multi-institutional study. Yonsei Med J. 2016;57(4):855-864. doi: 10.3349/ymj.2016.57.4.855

 

  1. Yang G, Zhang L, Liu M, Liu Q, Duan X, Bo J. CD163+ macrophages predict a poor prognosis in patients with primary T1 high-grade urothelial carcinoma of the bladder. World J Urol. 2019;37(12):2721-2726. doi: 10.1007/s00345-018-02618-1

 

  1. Ferro M, Katalin MO, Buonerba C, et al. Type 2 diabetes mellitus predicts worse outcomes in patients with high-grade T1 bladder cancer receiving Bacillus calmette-guérin after transurethral resection of the bladder tumor. Urol Oncol. 2020;38(5):459-464. doi: 10.1016/j.urolonc.2020.02.016

 

  1. Babjuk M, Burger M, Capoun O, et al. European association of urology guidelines on non-muscle-invasive bladder cancer (Ta, T1, and carcinoma in situ). Eur Urol. 2022;81(1):75-94. doi: 10.1016/j.eururo.2021.08.010

 

  1. Sataa S, Yassine N, Ghassen HH, et al. Contemporary management of stage T1 transitional cell carcinoma of the bladder. Tunis Med. 2005;83 Suppl 12:87-89.

 

  1. Babjuk M. What is the optimal treatment strategy for T1 bladder tumors? Eur Urol. 2010;57(1):32-34. doi: 10.1016/j.eururo.2009.10.015

 

  1. Hong X, Chen X, Wang H, et al. A HER2-targeted antibody-drug conjugate, RC48-ADC, exerted promising antitumor efficacy and safety with intravesical instillation in preclinical models of bladder cancer. Adv Sci (Weinh). 2023(32):e2302377. doi: 10.1002/advs.202302377

 

  1. Zhou Q, Ding W, Qian Z, et al. Immunotherapy strategy targeting programmed cell death ligand 1 and CD73 with macrophage-derived mimetic nanovesicles to treat bladder cancer. Mol Pharm. 2021;18(11):4015-4028. doi: 10.1021/acs.molpharmaceut.1c00448

 

  1. Hu H, Xia Q, Hu J, Wang S. Oncolytic viruses for the treatment of bladder cancer: Advances, challenges, and prospects. J Clin Med. 2022;11(23):6997. doi: 10.3390/jcm11236997

 

  1. Lichtenegger E, Koll F, Haas H, et al. The oncolytic adenovirus XVir-N-31 as a novel therapy in muscle-invasive bladder cancer. Hum Gene Ther. 2019;30(1):44-56. doi: 10.1089/hum.2018.026

 

  1. Zhang J, Liu K, Zhu Z, et al. Innovative strategies in genitourinary cancer: The role of oncolytic viruses. Front Oncol. 2024;14:1461324. doi: 10.3389/fonc.2024.1461324
Previous article in this issue
Share
Back to top
Bladder, Electronic ISSN: 2327-2120 Print ISSN: TBA, Published by POL Scientific
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept