Usefulness of pT1 substaging in papillary urothelial bladder carcinoma

Diagnostic Pathology

Renzo Colombo⁸  Tiziana Magnani⁷  Roberta Lucianò⁴  Giario Conti¹  Andrea Conti¹  Giorgio Guazzoni²  Lucia Ferrari³  Maurizio Colecchia⁶  Piergiuseppe Colombo⁵  Massimo Freschi⁴  Marco Moschini⁸  Rodolfo Hurle²  Carlo Patriarca³ 

[1] Department of Urology, Azienda Ospedaliera Sant’Anna, Como, Italy;Department of Urology, Humanitas Research Hospital, Rozzano (MI), Italy;Department of Pathology, Azienda Ospedaliera Sant’Anna, Como, 22020, Italy;Department of Pathology, Ospedale San Raffaele, Milan, Italy;Department of Pathology, Humanitas Research Hospital, Rozzano (MI), Italy;Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;Department of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;Department of Urology, Ospedale San Raffaele, Milan, Italy

关键词: Progression;    Prognosis;    Substaging system;    Stage;    Urothelial bladder carcinoma;   

Others  :  1235687
DOI  :  10.1186/s13000-016-0466-6

 received in 2015-12-02, accepted in 2016-01-14,  发布年份 2016

【 摘 要 】

Background

When treating bladder cancer patients, the most significant problems usually concern cases with high-grade non-muscle-invasive carcinoma, and a better understanding of which patients would benefit from early radical cystectomy is urgently needed. The uropathology community is seeking more user-friendly approaches to distinguishing between T1 cancers exhibiting different types of clinical behavior.

Methods

After a retrospective review, we selected a group of 314 patients who underwent transurethral resection of the bladder (TURB) and were diagnosed with high-grade urothelial carcinoma staged as T1. Three different substaging systems were applied: one was the anatomy-based T1 a/b; and two involved micrometric thresholds of either 0.5 mm of invasion (as proposed by van Rhijn et al.), or 1 mm of invasion (as proposed in the present study). Early reTUR (repeated transurethral resection) was performed in 250 patients, and the same substaging approaches were applied to cases of T1.

Results

It proved feasible to apply the 1 mm substaging system in 100 % of cases, the van Rhijn system in 100 %, and the anatomy-based method (T1 a/b) in 72.3 % of cases. At a mean follow-up of 46 months, the recurrence-free survival rate was significantly better (p < 0.001) in the group that underwent reTUR, while none of the three substaging systems reliably predicted recurrences. The 1 mm did seem promising, however, as a threshold for predicting progression, reaching statistical significance in the Kaplan Meier estimates (p < 0.04).

Conclusion

Our study shows that micrometric substaging is feasible in this setting and should be extended to include any early reTUR to complete the substaging done after the first TURB. It can also provide helpful prognostic information.

【 授权许可】

   
2016 Patriarca et al.

【 图 表 】

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