Vertical Lamina Propria Invasion Diagnosed by En Bloc Transurethral Resection is a Significant Predictor of Progression for pT1 Bladder Cancer

Abstract

Purpose: T1 bladder cancer is characterized by high recurrence and aggressive progression. Muscularis mucosae invasion may be a prognostic factor for progression, but the limitations of conventional transurethral resection of bladder tumors make diagnosis difficult. We correlated degree of invasion with oncologic outcome and evaluated the utility of pathological diagnosis following en bloc resection of bladder tumors. Materials and Methods: We retrospectively analyzed the records of 123 consecutive patients diagnosed with pT1 bladder cancer between November 2013 and December 2018. Transurethral resection was conducted in 91 patients, and en bloc resection in 32 patients. All specimens were analyzed for invasion depth and pT1 substaging (T1a/b: invasion above or into/beyond muscularis mucosae, pT1m/e: microinvasive or extensively invasive). Primary end points were prognostic values of pT1 substaging and invasion depth. The secondary end point was the pathological diagnostic utility of en bloc resection. Results: Median followup was 23 months. Three-year progression-free survival rate differed significantly depending on muscularis mucosae invasion (pT1a: 97.3%, pT1b: 72.8%; p[0.003) and invasion depth from basal membrane (<2 mm: 90.6%, !2 mm: 77.9%; p[0.03). Multivariate analysis showed that sessile tumor and invasion depth from basal membrane !2 mm were independent prognostic factors for progression. Diagnostic rates for pT1a/b and invasion depth were 77.6% and 85.9%, respectively, with transurethral resection, but 100% and 100% with en bloc resection (p[0.01 and p[0.03). Conclusions: Vertical lamina propria invasion is predictive of progression in T1 bladder cancer, underlining the importance of accurately diagnosing the degree of vertical lamina propria invasion with en bloc resection.

Oncological impact of cystoscopic findings in non‐muscle‐invasive bladder cancer: a meta‐analysis

“…After screening, a full‐text review was performed for 201 articles. According to the inclusion criteria, we finally identified 72 studies comprising 28 139 patients eligible for the meta‐analysis [12–83]. The demographics of each included study are shown in Table 1 and Table S2.…”

En bloc resection, is this the future of non-muscle invasive bladder cancer management? Presentation of our technique and brief review of the literature

“…3 Recent evidence underlines its importance in accurately diagnosing the degree of vertical lamina progression, with the latter having an impact on progression-free survival in patients diagnosed with pT1 bladder cancer. 12 Moreover a study of NMIBC 123 patients (TURBT, n = 91, ERBT, n = 32) with pT1 disease showed that both diagnostic time and interobserver variability for T1 sub-staging favor ERBT. 13 In light of the plethora of technological advancements there is a multitude of available ways to perform ERBT ranging from use of a modified J-loop electrode and Collins knife to specifically designed bipolar electrocautery loops and HybridKnife ® endoscopic submucosal hydro-dissection.…”

“…3 Recent evidence underlines its importance in accurately diagnosing the degree of vertical lamina progression, with the latter having an impact on progression-free survival in patients diagnosed with pT1 bladder cancer. 12 Moreover a study of NMIBC 123 patients (TURBT, n = 91, ERBT, n = 32) with pT1 disease showed that both diagnostic time and inter-observer variability for T1 sub-staging favor ERBT. 13…”

Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer?

“…Finally, we identified and incised the shallow MP layer and removed the tumour en bloc , including the MP. Biopsy forceps were used to extract the specimen [ 15 ]. When the tumour was too large to extract through the outer cylinder, we cut the surface of the tumour with a conventional loop‐type electrode ( n = 23).…”