BACKGROUND: The existence and prognosis of T1LG (T1 low-grade) bladder cancer is controversial. Also, because of data paucity, it remains unclear what is the clinical history of bacillus Calmette-Guérin (BCG) treated T1LG tumors and if it differs from other NMIBC (non-muscle-invasive bladder cancer) representatives. The aim of this study was to analyse recurrence-free survival (RFS) and progression-free survival (PFS) in patients with T1LG bladder cancers treated with BCG immunotherapy. METHODS: A multi-institutional and retrospective study of 2510 patients with Ta/T1 NMIBC with or without carcinoma in situ (CIS) treated with BCG (205 T1LG patients) was performed. Kaplan-Meier estimates and log-rank test for RFS and PFS to compare the survival between TaLG, TaHG, T1LG, and T1HG NMIBC were used. Also, T1LG tumors were categorized into EAU2021 risk groups and PFS analysis was performed, and Cox multivariate model for both RFS and PFS were constructed. RESULTS: The median follow-up was 52 months. For the T1LG cohort, the estimated RFS and PFS rates at 5-year were 59.3% and 89.2%, respectively. While there were no differences in RFS between NMIBC subpopulations, a slightly better PFS was found in T1LG NMIBC compared to T1HG (5-year PFS; T1LG vs. T1HG: 82% vs. 89%; P<0.001). A heterogeneous classification of patients with T1LG NMIBC was observed when EAU 2021 prognostic model was applied, finding a statistically significant worse PFS in patients classified as high-risk T1LG (5-year PFS; 81.8%) compared to those in intermediate (5-year PFS; 93,4%), and low-risk T1LG tumors (5-year PFS; 98,1%). CONCLUSIONS: The RFS of T1LG was comparable to other NMIBC subpopulations. The PFS of T1LG tumors was significantly better than of T1HG NMIBC. The EAU2021 scoring model heterogeneously categorized the risk of progression in T1LG tumors and the high-risk T1LG had the worst PFS.

Department of Minimally Invasive Robotic Urology Center of Excellence in Urology Wrocław Medical University Wrocław Poland

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Claude Huriez Hospital CHU Lille Lille France

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology Erasme Hospital University Clinics of Brussels Free University of Brussels Brussels Belgium

Department of Urology Hospital Clínico San Carlos Madrid Spain

Department of Urology IRCCS and quot;Regina Elena and quot; National Cancer Institute Rome Italy

Department of Urology Medical University of Innsbruck Innsbruck Austria

Department of Urology Netherlands Cancer Institute Amsterdam the Netherlands

Department of Urology Pitié Salpêtrière Hospital APHP Sorbonne University Paris France

Department of Urology Puigvert Foundation Autonomous University of Barcelona Barcelona Spain

Department of Urology Ramón y Cajal University Hospital IRYCIS University of Alcala Madrid Spain

Department of Urology Saint Louis Hospital APHP Paris Cité University Paris France

Department of Urology The Jikei University School of Medicine Tokyo Japan

Department of Urology Torrejon University Hospital Madrid Spain

Department of Urology Umberto 1 Polyclinic Hospital Sapienza University Rome Italy

Department of Urology University Hospitals Leuven Leuven Belgium

Department of Urology University of Texas Southwestern Dallas TX USA

Department of Urology Weill Cornell Medical College New York NY USA

Division of Clinical Pathology Department of Clinical and Experimental Pathology Wroclaw Medical University Wrocław Poland

Division of Experimental Oncology Department of Urology Urological Research Institute Vita Salute San Raffaele University Milan Italy

Division of Urology Department of Surgical Sciences Molinette Hospital University of Turin School of Medicine Turin Italy

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan

Section of Pathological Anatomy Polytechnic University of Marche Ospedali Riuniti Ancona Italy

Unit of Oncologic Minimally Invasive Urology and Andrology Department of Experimental and Clinical Medicine Careggi University Hospital University of Florence Florence Italy

Minerva Urol Nephrol. 2023 Dec;75(6):773-775. doi: 10.23736/S2724-6051.23.05636-7. PubMed

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