Comparative differences between T1a/b and T1e/m as substages in T1 urothelial carcinoma of the bladder

Abstract

ObjectiveTo evaluate the prognostic value of the depth of lamina propria invasion in patients with T1 bladder cancer and to display comparative differences between the T1a/b and T1e/m substaging systems.Patients and MethodsThis study included 106 patients with primary stage T1 urothelial bladder tumours who underwent surgery between January 2009 and December 2014. Pathologic specimens were re-evaluated to confirm the diagnosis of T1 and substaging by the same pathologist using two systems: T1a and T1b, and T1m and T1e. Age, tumour size, multiplicity, associated carcinoma in situ, tumour grade, and T1 substaging system were investigated to detect the relation between disease progression and recurrence.ResultsThe recurrence rate was 52% for T1a (n=42) vs. 76% for T1b (n=20) (p=0.028) and 55% for T1m (n=32) vs. 62% for T1e (n=30), respectively (p=0.446). There was no significant difference between the substaging groups for disease progression: T1a (n=12, 15%) vs. T1b (n=7, 27%), and T1m (n=8, 13.8%) vs. T1e (n=11, 23%) (p>0.05). In the multivariate analysis, tumour size >3 cm (p=0.008), multiplicity (p=0.049), and substaging T1b (p=0.043) were independent predictive factors for tumour recurrence. According to the Kaplan-Meier actuarial method, recurrence-free survival was significantly different in patients with pT1a tumours compared with those with pT1b tumours (p=0.033).ConclusionsSubstaging T1 provides a prediction of disease recurrence. Regarding recurrence, T1a/b substaging can provide better knowledge of disease behaviour because it is predicted as more superior than T1 m/e, and it can help in determining the requirement for early cystectomy.

Substaging of pT1 Urothelial Bladder Carcinoma Predicts Tumor Progression and Overall Survival

“…This may be ascribed to the surprising fact that there was a trend for a higher rate CIS in pT1a tumor as compared to pT1b and pT1c, possibly related to observational operator-dependent variability. Interestingly, the absence of association between CIS and T1 tumors with a worse prognosis was also reported in 3 other series [8, 16, 24].…”

Prognostic value of T1 substaging on oncological outcomes in patients with non-muscle-invasive bladder urothelial carcinoma: a systematic literature review and meta-analysis

“…Median: 60 months Nishiyama [30] Mean: 68.5 S (for DR) Mean: 74.0 months Rouprêt [38] Median: 70 S Mean: 44 months (range, 6-161) Soukup [41] Median: 68.83 (17.55-86.94) S (for PFS, CSS, OS) Median: 3.13 years (0.1-10.5) Hu [25] Mean: 70 years (56-94) S (in aggregate length of invasion; > 0.5 cm) N/A D. E. Marco [44] Mean: 69.9 NS Median: 9.5 years Lim [28] Mean: 68.9 (20-93) S (for PFS) Mean: 73.3 months (range, 3.9-187.9) Orsola [15] Median: 71 S (for DP) Median: 71 months (range: 5-107) Patschan [36] Median: 74 NS (3 years follow-up in analysis) Patriarca [35] Mean: 71. [43] Mean: 67.9 S (in T1a/b substaging for DR) Mean: 54 months…”

“…MM is identified in 12-83% of bladder biopsy specimen [53,54]. Therefore, some studies proposed identification of large vessels of the vascular plexus as an alternative tumor extension marker in specimens without obvious MM [43,46]. Moreover, although a cut-off point of 5 mm has been proposed in several studies to define tumor infiltration depth, other studies have utilized other definitions [8,35].…”

Clinical significance and effect of MTDH/AEG-1 in bladder urothelial cancer: a study based on immunohistochemistry, RNA-seq, and in vitro verification

“…Bladder cancer (BC) is one of the most aggressive urological malignancies, with an incidence of 79,030 cases and 16,870 deaths in the United States in 2017 1–4. Bladder urothelial carcinoma (BUC), the most common type of BC, is generally diagnosed at an advanced stage, leading to poor prognosis 5,6. Hence, investigation and development of the underlying biological mechanisms that promote BUC tumorigenesis is a vital clinical research area.…”