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… Show more
“…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].…”
<b><i>Introduction:</i></b> Limitations in tumor staging and the heterogeneous natural evolution of pT1 urothelial bladder carcinoma (UBC) make the choice of treatment challenging. We evaluated if histopathological substaging (pT1a, pT1b, and pT1c) helps predict disease recurrence, progression, and overall survival following transurethral resection of the bladder (TURB). <b><i>Methods:</i></b> We included 239 consecutive patients diagnosed with pT1 UBC at TURB in a single institution since 2001. Each sample was interpreted by our specialized uropathologists trained to subclassify pT1 stage. Three groups were distinguished according to the degree of invasion: T1a (up to the muscularis mucosae [MM]), T1b (into the MM), and T1c (beyond the MM). <b><i>Results:</i></b> T1 substaging was possible in 217/239 (90%) patients. pT1a, b, and c occurred in 124 (57), 59 (27), and 34 (16%), respectively. The median follow-up was 3.1 years, with a cumulative recurrence rate of 52%, progression rate of 20%, and survival rate of 54%. Recurrence was not significantly associated with tumor substage (<i>p</i> = 0.61). However, the Kaplan-Meier survival analysis showed a significantly higher progression rate among T1b (31) and T1c (26%) tumors than T1a (13%) (log-rank test: <i>p</i> = 0.001) stages. In a multivariable model including gender, age, ASA score, smoking, tumor grade, and presence of carcinoma in situ, T1 substage was the single variable significantly associated with progression-free survival (HR 1.7, <i>p</i> = 0.005). Nineteen patients (9%) needed radical cystectomy; among them, 12/19 (63%) had an invasive tumor. Overall survival was significantly associated with tumor substaging (<i>p</i> = 0.001). <b><i>Conclusion:</i></b> Histopathological substaging of pT1 UBC is significantly associated with tumor progression and overall survival and therefore appears to be a useful prognostic tool to counsel patients about treatment options.
“…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].…”
<b><i>Introduction:</i></b> Limitations in tumor staging and the heterogeneous natural evolution of pT1 urothelial bladder carcinoma (UBC) make the choice of treatment challenging. We evaluated if histopathological substaging (pT1a, pT1b, and pT1c) helps predict disease recurrence, progression, and overall survival following transurethral resection of the bladder (TURB). <b><i>Methods:</i></b> We included 239 consecutive patients diagnosed with pT1 UBC at TURB in a single institution since 2001. Each sample was interpreted by our specialized uropathologists trained to subclassify pT1 stage. Three groups were distinguished according to the degree of invasion: T1a (up to the muscularis mucosae [MM]), T1b (into the MM), and T1c (beyond the MM). <b><i>Results:</i></b> T1 substaging was possible in 217/239 (90%) patients. pT1a, b, and c occurred in 124 (57), 59 (27), and 34 (16%), respectively. The median follow-up was 3.1 years, with a cumulative recurrence rate of 52%, progression rate of 20%, and survival rate of 54%. Recurrence was not significantly associated with tumor substage (<i>p</i> = 0.61). However, the Kaplan-Meier survival analysis showed a significantly higher progression rate among T1b (31) and T1c (26%) tumors than T1a (13%) (log-rank test: <i>p</i> = 0.001) stages. In a multivariable model including gender, age, ASA score, smoking, tumor grade, and presence of carcinoma in situ, T1 substage was the single variable significantly associated with progression-free survival (HR 1.7, <i>p</i> = 0.005). Nineteen patients (9%) needed radical cystectomy; among them, 12/19 (63%) had an invasive tumor. Overall survival was significantly associated with tumor substaging (<i>p</i> = 0.001). <b><i>Conclusion:</i></b> Histopathological substaging of pT1 UBC is significantly associated with tumor progression and overall survival and therefore appears to be a useful prognostic tool to counsel patients about treatment options.
“…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…”
Section: Discussionmentioning
confidence: 99%
“…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].…”
Purpose To evaluate the prognostic value of substaging on oncological outcomes in patients with T (or pT1) urothelial carcinoma of the bladder. Methods A literature search using PubMed, Scopus, Web of Science, and Cochrane Library was conducted on March 2019 to identify relevant studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. The pooled disease recurrence (DR) and disease progression (DP) rate in T1(or pT1) patients were calculated using a fixed or random effects model. Results Overall 36 studies published between 1994 and 2018 including a total of 6781 bladder cancer patients with T1(or pT1) stage were selected for the systematic review and meta-analysis. Twenty-nine studies reported significant association between tumor infiltration depth or muscularis mucosa (MM) invasion and oncological outcomes. Totally 12 studies were included in the meta-analysis. MM invasion (T1a/b/c [or pT1a/b/c] or T1a/b [or pT1a/b] substaging system) was associated with DR (pooled HR: 1.23, 95%CI: 1.01-1.49) and DP (pooled HR: 2.61, 95%CI: 1.61-4.23). Tumor infiltration depth (T1 m/e [or pT1 m/e] substaging system) was also associated with DR (pooled HR: 1.49, 95%CI: 1.11-2.00) and DP (pooled HR: 3.29, 95%CI: 2.39-4.51). Conclusions T1(or pT1) substaging in patients with bladder cancer is of prognostic value as it is associated with oncologic outcomes. Inclusion of this factors into the clinical decision-making process of this heterogeneous tumor may improve outcomes, while avoiding over-and under-treatment for T1(or pT1) bladder cancer.
“…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.…”
BackgroundOverexpression of metadherin/astrocyte elevated gene-1 (MTDH/AEG-1) has been implicated in various cancers. However, the clinical significance and the potential biological functions of MTDH/AEG-1 in bladder urothelial carcinoma (BUC) are not established.MethodsIn this study, the expression of MTDH/AEG-1in BUC was measured using the Cancer Genome Atlas (TCGA) database and immunohistochemistry, together with a meta-analysis, to investigate the expression and diagnostic value of MTDH/AEG-1. The possible association between MTDH/AEG-1 expression and the viability, proliferation, and apoptosis in BUC cell lines (T24, HT1376, and RT4) was also assessed in vitro by viability, MTS, colony formation, and caspase-3/7 assays, as well as Hoechst 33342 and propidium iodide (PI) double staining.ResultsMTDH/AEG-1 expression was significantly higher in BUC tissues than in normal bladder tissues, according to the TCGA and immunohistochemistry results, and these findings were verified by the meta-analysis. Functional knockdown of MTDH/AEG-1 suppressed BUC cell growth and induced apoptosis. Bioinformatics analyses indicated an involvement of MTDH/AEG-1 in several processes, including RNA binding, protein transport, intracellular transport, and the insulin signaling pathway.ConclusionWe hypothesize that MTDH/AEG-1 could play essential roles in BUC, especially in cell growth and apoptosis, via the insulin signaling pathway.”
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