Substaging by estimating the size of invasive tumour can improve risk stratification in pT1 urothelial bladder cancer-evaluation of a large hospital-based single-centre series

Bertz, Simone; Denzinger, Stefan; Otto, Wolfgang; Wieland, Wolf F.; Stoehr, Robert; Hofstaedter, Ferdinand; Hartmann, Arndt

doi:10.1111/j.1365-2559.2011.03989.x

Cited by 70 publications

(78 citation statements)

References 31 publications

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“…Numerous research groups worldwide have scrutinized a wide array of parameters to identify prognostic factors that may help to predict tumour progression in stage pT1 UBC [18-24]. Among these parameters grading appears to constitute the most powerful prognostic histopathological feature.…”

Section: Discussionmentioning

confidence: 99%

Loss of aquaporin 3 protein expression constitutes an independent prognostic factor for progression-free survival: an immunohistochemical study on stage pT1 urothelial bladder cancer

et al. 2012

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BackgroundTreatment of patients with stage pT1 urothelial bladder cancer (UBC) continues to be a challenge due to its unpredictable clinical course. Reliable molecular markers that help to determine appropriate individual treatment are still lacking. Loss of aquaporin (AQP) 3 protein expression has previously been shown in muscle-invasive UBC. The aim of the present study was to investigate the prognostic value of AQP3 protein expression with regard to the prognosis of stage pT1 UBC.MethodAQP 3 protein expression was investigated by immunohistochemistry in specimens of 87 stage T1 UBC patients, who were diagnosed by transurethral resection of the bladder (TURB) and subsequent second resection at a high-volume urological centre between 2002 and 2009. Patients underwent adjuvant instillation therapy with Bacillus Calmette-Guérin (BCG). Loss of AQP3 protein expression was defined as complete absence of the protein within the whole tumour. Expression status was correlated retrospectively with clinicopathological and follow-up data (median: 31 months). Multivariate Cox regression analysis was used to assess the value of AQP3 tumour expression with regard to recurrence-free (RFS), progression-free (PFS) and cancer-specific survival (CSS). RFS, PFS and CSS were calculated by Kaplan-Meier analysis and Log rank test.Results59% of patients were shown to exhibit AQP3-positive tumours, whereas 41% of tumours did not express the marker. Loss of AQP3 protein expression was associated with a statistically significantly worse PFS (20% vs. 72%, p=0.020). This finding was confirmed by multivariate Cox regression analysis (HR 7.58, CI 1.29 – 44.68; p=0.025).ConclusionsLoss of AQP3 protein expression in pT1 UBC appears to play a key role in disease progression and is associated with worse PFS. Considering its potential prognostic value, assessment of AQP3 protein expression could be used to help stratify the behavior of patients with pT1 UBC.

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Section: Discussionmentioning

confidence: 99%

Loss of aquaporin 3 protein expression constitutes an independent prognostic factor for progression-free survival: an immunohistochemical study on stage pT1 urothelial bladder cancer

et al. 2012

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“…Recently, shortcomings of current grading systems for prognostic assessment were suggested [23]. Likewise, substaging of pT1 NMIBC in relation to depth of lamina propria invasion has been proposed due to inaccuracy of prognostic assessment [24,25]. Molecular markers seem not to suffice in this regard and require further assessment [5,26,27].…”

Section: Discussionmentioning

confidence: 99%

Oncological Outcome of Primary versus Secondary Muscle-Invasive Bladder Cancer Is Comparable after Radical Cystectomy

et al. 2013

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Background: High-risk non-muscle-invasive bladder cancer (NMIBC) progressing to muscle-invasive bladder cancer (MIBC) is associated with adverse tumour biology. It is unclear, however, whether outcome of NMIBC progressing to MIBC is adverse compared to primary MIBC and whether NMIBC of higher risk of progression to MIBC is adverse compared to NMIBC of lower risk. Objective: Our objective was to assess cancer-specific survival (CSS) following radical cystectomy (RC) for primary MIBC and for NMIBC progressing to MIBC in dependence of EORTC risk score. Materials and Methods: Clinical and histopathological characteristics and CSS of 150 patients were assessed. Secondary MIBCs were stratified by EORTC risk score at the last transurethral resection of bladder tumour for NMIBC. Results: CSS did not differ significantly between primary and secondary MIBC (p = 0.521). Secondary MIBC with high EORTC score had significantly shorter CSS compared to secondary MIBC with intermediate EORTC score (p = 0.029). In multivariable analysis, pathological tumour stage (HR = 3.77; p = 0.020) and lymph node stage (HR = 2.34; p = 0.022) were significantly correlated with CSS. Conclusion: While the outcome of secondary MIBC is not generally adverse compared to primary MIBC, the EORTC risk score not only reflects high risk of progression of NMIBC to MIBC, but also worse outcome following RC for secondary MIBC. Timely RC should thus be debated in high-risk NMIBC.

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“…However, the old WHO 1973 classification system, discerning G2 and G3 tumors, still has prognostic value compared with the more recent WHO 2004 system [8][9][10]. Consequently, the European Association of Urology guidelines continue to support the WHO 1973 system [2].…”

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confidence: 95%

“…The main reason was lack of consensus regarding the identification of the MM-VP at the invasion front of the tumor and the inability to substage patients in a significant percentage (up to 42%) of cases [1,[5][6][7]. To circumvent this problem, new reproducible and user-friendly systems for T1 substage were developed, for example, the system that discerns T1-microinvasive (T1m) and T1-extensive-invasive (T1e) tumors [1,[6][7][8]. In two head-to-head comparisons, T1m and T1e proved more user friendly, could be used in 100% of cases, and predicted progression in multivariable analyses, making them more robust tools to substage T1 BCa than T1a-T1c [6,8].…”

mentioning

confidence: 99%

“…To circumvent this problem, new reproducible and user-friendly systems for T1 substage were developed, for example, the system that discerns T1-microinvasive (T1m) and T1-extensive-invasive (T1e) tumors [1,[6][7][8]. In two head-to-head comparisons, T1m and T1e proved more user friendly, could be used in 100% of cases, and predicted progression in multivariable analyses, making them more robust tools to substage T1 BCa than T1a-T1c [6,8]. If further confirmed, substage (T1m and T1e) has the potential to be incorporated into future TNM classifications.…”

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confidence: 99%

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Toward Optimal Prediction of Prognosis in T1 Urothelial Carcinoma of the Bladder

2015

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Substaging by estimating the size of invasive tumour can improve risk stratification in pT1 urothelial bladder cancer-evaluation of a large hospital-based single-centre series

Cited by 70 publications

References 31 publications

Loss of aquaporin 3 protein expression constitutes an independent prognostic factor for progression-free survival: an immunohistochemical study on stage pT1 urothelial bladder cancer

Loss of aquaporin 3 protein expression constitutes an independent prognostic factor for progression-free survival: an immunohistochemical study on stage pT1 urothelial bladder cancer

Oncological Outcome of Primary versus Secondary Muscle-Invasive Bladder Cancer Is Comparable after Radical Cystectomy

Toward Optimal Prediction of Prognosis in T1 Urothelial Carcinoma of the Bladder

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