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UPJ INSIGHT Oncologic Outcomes of cT1 and cT2 Micropapillary Variant Compared with cT1 and cT2 Conventional Urothelial Carcinoma Treated with Radical Cystectomy

By: Kevin B. Ginsburg, MD, MS; Jared P. Schober, MD; Laura Bukavina, MD, MPH; Nicole Murray, MPH; Akhil A. Chandra, MPH; David Y. T. Chen, MD; Richard E. Greenberg, MD; Rosalia Viterbo, MD; Robert G. Uzzo, MD, MBA; Marc C. Smaldone, MD, MSHP; Alexander Kutikov, MD; Andres F. Correa, MD | Posted on: 01 Oct 2022

Ginsburg KB, Schober JP, Bukavina L, et al. Oncologic outcomes of ct1 and ct2 micropapillary variant compared with ct1 and ct2 conventional urothelial carcinoma treated with radical cystectomy. Urol Pract. 2022;9(5)396-404.

Study Need and Importance

Guideline statements tend to favor early radical therapy for patients with clinical T stage (cT) 1 micropapillary bladder cancer (MPBC) as opposed to bladder preservation with transurethral resection of bladder tumor (TURBT) and intravesical therapy, which is the accepted standard for cT1 urothelial cell bladder cancer (UCBC). We aimed to compare the difference in oncologic outcomes of patients with cT1 and cT2 MPBC and UCBC treated with radical cystectomy (RC). We compared patients with cT1 MPBC and de novo cT2 MPBC to infer the oncologic risk associated with progression from cT1 to cT2 disease that may occur while attempting bladder preservation with TURBT and intravesical therapy.

What We Found

In 23,871 patients with MPBC (1.6%) and UCBC (98%) in the National Cancer Database treated with RC, patients with MPBC had more upgrading to advanced pathological stage at RC (≥pT3–cT1 MPBC: 31%; cT2 MPBC: 44%; cT1 UCBC: 18%; cT2 UCBC: 27%) and pathologically node positive disease (cT1 MPBC: 34%; cT2 MPBC: 60%; cT1 UCBC: 14%; cT2 MPBC: 24%) compared with UCBC (see Figure). Overall survival probability was similar between patients with cT1 MPBC and cT1 UCBC. Patients with cT2 MPBC had worse survival than patients with cT2 UCBC.

Figure. Proportion of patients with advanced pathological stage (a) and pathological node positive disease (b). Error bars display the 95% CI.


The National Cancer Database records treatments administered or planned in the first treatment course prior to recurrence or progression. We are unable to include in this study a group of patients with cT1 MPBC who were treated with TURBT and intravesical therapy who progressed to cT2 disease prior to RC for comparison.

Interpretation for Patient Care

The difference in oncologic outcomes for cT1 and cT2 MPBC exceeds the observed risk of progression from cT1 to cT2 UCBC. Patients should consider the degree that oncologic control is diminished when treating an MPBC at stage cT2 compared with cT1 when considering treatment options for cT1 MPBC.