What is the prognosis of invasive bladder cancer with muscularis propria invasion?

From the Guidelines

The prognosis for invasive bladder cancer with muscularis propria invasion is generally poor, with a 5-year cancer-specific survival rate of less than 50% for patients with pT2-pT3 tumors and less than 10% for those with pT4 tumors.

Key Points

• The prognosis is influenced by the stage of the cancer, with more advanced stages having a poorer prognosis 1.
• Treatment typically involves radical cystectomy (complete removal of the bladder) combined with chemotherapy, with the standard chemotherapy regimen being usually cisplatin-based 1.
• Patients should expect a lengthy recovery period after surgery, including adapting to urinary diversion methods like an ileal conduit or neobladder.
• Close follow-up with regular imaging and cystoscopies is crucial to monitor for recurrence.

Prognostic Factors

• The presence of concomitant carcinoma in situ (CIS) of the upper tract is between 11% and 36% 1.
• The most common symptom is haematuria (70%-80%) or flank pain (10%-20%) 1.
• The key investigations for upper tract urothelial carcinoma (UTUC) are CT urography and diagnostic ureteroscopy 1.

Treatment Options

• Kidney-sparing management, such as endoscopic laser ablation, should be offered as primary treatment option to patients with low-risk UTUC 1.
• High-risk UTUC patients should undergo open or laparoscopic radical nephroureterectomy with bladder cuff excision regardless of tumor location 1.
• Systemic therapy for advanced disease should follow the recommendations for urothelial bladder cancer, including adjuvant cisplatin-based chemotherapy 1.

From the Research

Prognosis of Invasive Bladder Cancer with Muscularis Propria Invasion

The prognosis of invasive bladder cancer with muscularis propria invasion is generally poor, but it can vary depending on several factors, including the stage and grade of the tumor, lymph node status, and the presence of metastasis.

• The 5-year survival rate for patients with muscularis propria invasion (T2) is around 40-50% 2, 3.
• A study found that the 5-year survival rate for patients with T2 tumors was 40% 2.
• Another study reported a 5-year progression-free survival rate of 49% and an overall survival rate of 46% for patients with primary muscle invasion (T2) 3.
• The lymph node status is also an important prognostic factor, with patients having negative lymph nodes (N0) having a better prognosis than those with positive lymph nodes (N1-3) 4, 3.
• A study found that the 5-year survival rate for patients with N0 disease was 64%, compared to 48% for those with N1 disease and 14% for those with N2-3 disease 4.
• The use of neoadjuvant chemotherapy or radiotherapy may not improve survival rates for patients with muscularis propria invasion 4, 5.
• However, a study found that definitive therapy (either radical cystectomy in conjunction with neoadjuvant chemotherapy or trimodal therapy) was associated with a significant survival benefit compared to non-definitive therapy (including palliative transurethral resection, chemotherapy, and radiation treatment) 5.