The Prognostic Value of T1 Bladder Cancer Substaging: A Single Institution Retrospective Study

Abstract

Objective: To evaluate the prognostic value of the depth of lamina propria invasion in patients with T1 bladder cancer. Subjects and Methods: 200 patients were treated between the years 2002 and 2009. Tumours with depth of invasion above the muscularis mucosae level were categorised as pT1a and those with depth of invasion up to or beyond the muscularis mucosae as pT1b. Results: Categorisation for pT1a and pT1b was performed in 176 of 200 patients (88%). In 10 patients a muscle-invasive tumour was found in re-transurethral resection samples. 131 (79%) of 166 analysed patients had pT1a tumour and 35 (21%) had pT1b tumour. During the follow-up, in 101 (61%) patients the tumour had recurred and in 27 (16.3%) the tumour had progressed. Of all the investigated parameters, T1 substaging (p < 0.0001), grade (p = 0.0003) and the number of bacillus Calmette-Guérin instillations (p = 0.0490) were significant in predicting progression. The only significant factor for disease-specific survival was T1 substaging in univariable (p = 0.0008) and multivariable (hazard ratio 4.407) analysis. T1 substaging (p = 0.0149) and tumour multiplicity (p = 0.0448) have a statistically significant prognostic value with respect to overall survival. Conclusions: Deep invasion of the lamina propria is a significant adverse prognostic factor for tumour progression, disease-specific survival and overall survival.

Infiltrative lamina propria invasion pattern as an independent predictor for cancer‐specific and overall survival of instillation treatment‐naïve stage T1 high‐grade urothelial bladder cancer

“…1,2 In 2004, a two-tiered new classification system for grade (low vs high grade) was accepted by the WHO to improve reproducibility and prognosis compared with the "old" WHO 1973 classification system. 3,19 Looking at the results of the present study and many other reports, the WHO 3,6,9,[19][20][21] This is the main reason why the EAU still holds onto WHO 1973 in their NMIBC guidelines. 3,19 Looking at the results of the present study and many other reports, the WHO 3,6,9,[19][20][21] This is the main reason why the EAU still holds onto WHO 1973 in their NMIBC guidelines.…”

“…3,19 Looking at the results of the present study and many other reports, the WHO 3,6,9,[19][20][21] This is the main reason why the EAU still holds onto WHO 1973 in their NMIBC guidelines. [1][2][3]5,6,9,16,20,21 Traditionally, T1 BC has been substaged according to invasion above (T1a) and in/beyond (T1b/c) the muscularis mucosae, a thin layer of smooth muscle fibers within the lamina propria. Stage T1 substage has been shown to be highly prognostic in many studies.…”

“…3,19 Looking at the results of the present study and many other reports, the WHO 1973 classification system can be considered superior to WHO 2004 for T1 BC. 3,6,9,[19][20][21] This is the main reason why the EAU still holds onto WHO 1973 in their NMIBC guidelines. 2 Substaging is another concept to possibly discern indolent from aggressive T1 BC.…”

Staging of bladder cancer

“…69 Nonetheless, beginning in 1990 with Younes et al, 62 many studies have investigated pT1 substaging relative to the muscularis mucosae and/or vascular plexus with mixed, but generally positive, results. 26,[45][46][47][48][49]54,[58][59][60][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86] Some of these studies substaged pT1 into three categories (i.e. above, into or below the muscularis mucosae/vascular plexus), while others utilised only two substages (i.e.…”

The Moreau Strain of Bacillus Calmette-Guerin (BCG) for High-Risk Non-Muscle Invasive Bladder Cancer: An Alternative during Worldwide BCG Shortage?

“…In this regard, immunotherapy with Bacillus Calmette-Guerin (BCG) has been the standard of care for more than 3 decades [8,9]. Although up to 80% of patients initially respond to this treatment [10,11], more than 50% are expected to experience disease recurrence within 5 years, and about 10-20% experience disease progression to muscle-invasive 1 stage [3,10,12,13]. …”