Neoplastic invasion of the connective stalks in transitional cell papillary tumors (TCPT) of the bladder

Tommasini-Degna, Antonio; Negri, Rosa

doi:10.1007/bf00256332

Cited by 2 publications

(2 citation statements)

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“…These invasive cells and tumour nests are still confined within the exophytic tumour component at a significant distance from the proper bladder wall and associated deeper vasculature, and are thus less likely to spread and progress than tumours invading the PUC base. The significance of separating stalk‐invasive tumours was recognized earlier in a few studies, a systematic approach and strict selection criteria were lacking . For instance, studies by Hermann and Tommasini‐Degna included in their cohorts cases with associated CIS, thus increasing the numbers of patients but potentially affecting outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The significance of separating stalk‐invasive tumours was recognized earlier in a few studies, a systematic approach and strict selection criteria were lacking . For instance, studies by Hermann and Tommasini‐Degna included in their cohorts cases with associated CIS, thus increasing the numbers of patients but potentially affecting outcomes. The pT1 tumours were substaged into: pT1a—invasion of the tumour stalk without involvement of the LP under the stalk; pT1b—LP invasion under the tumour stalk but superficial to the MM; and pT1c—invasion into or deeper than the MM without involvement of the muscularis propria .…”

Section: Discussionmentioning

confidence: 99%

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Stalk versus base invasion in pT1 papillary cancers of the bladder: improved substaging system predicting the risk of progression

2017

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Aims Pathologic stage T1 (pT1) bladder cancers are a clinically heterogeneous group. However, current staging guidelines for superficially invasive cancers do not acknowledge the variability in type and extent of lamina propria invasion in papillary urothelial carcinomas (PUC), and historically proposed substaging systems showed either high inter-observer variation or limited value in predicting patient outcomes. Herein we reappraise pT1 PUC substaging, aiming to identify a novel scheme which is reproducible and prognostically meaningful. Methods and results Stage pT1 PUC diagnosed during years 1999–2015 were retrospectively reviewed and characterized as focal invasion confined to papillary stalk, focal invasion of tumor base, or extensive invasion of tumor base. Cases with concurrent flat carcinoma in-situ, angiolymphatic invasion, absent muscularis propria, or clinically advanced disease were excluded. We calculated cumulative incidence of recurrence, progression, and death by tumor subtype and evaluated differential risks using log-rank tests and Kaplan-Meier curves stratified by type and extent of invasion. Among 62 patients satisfying inclusion criteria, 22 of 29 patients with base extensive invasion progressed while 4 of 13 with base focal and 0 of 20 with stalk only invasion progressed. There was strong evidence that base extensive patients had higher risk of progression and death due to bladder cancer than base focal or stalk only counterparts (P<0.0001). However, tumor subtype was not significantly associated with risk of recurrence (P=0.21). Conclusions We propose an innovative substaging approach for reporting site and extent of lamina propria invasion in patients with pT1 PUC allowing patient stratification for risk of progression.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%