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Usefulness of pT1 substaging in papillary urothelial bladder carcinoma.
- Source :
-
Diagnostic pathology [Diagn Pathol] 2016 Jan 20; Vol. 11, pp. 6. Date of Electronic Publication: 2016 Jan 20. - Publication Year :
- 2016
-
Abstract
- 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.<br />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.<br />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).<br />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.
- Subjects :
- Aged
Carcinoma, Papillary mortality
Carcinoma, Papillary secondary
Carcinoma, Papillary surgery
Cystectomy methods
Disease Progression
Disease-Free Survival
Feasibility Studies
Female
Humans
Italy
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Predictive Value of Tests
Proportional Hazards Models
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Urinary Bladder Neoplasms mortality
Urinary Bladder Neoplasms surgery
Carcinoma, Papillary pathology
Decision Support Techniques
Neoplasm Staging methods
Urinary Bladder Neoplasms pathology
Urothelium pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1746-1596
- Volume :
- 11
- Database :
- MEDLINE
- Journal :
- Diagnostic pathology
- Publication Type :
- Academic Journal
- Accession number :
- 26791567
- Full Text :
- https://doi.org/10.1186/s13000-016-0466-6