TY - JOUR
T1 - A New and Highly Prognostic System to Discern T1 Bladder Cancer Substage
AU - van Rhijn, BWG (Bas)
AU - Kwast, Theodorus
AU - Alkhateeb, SS
AU - Fleshner, NE
AU - van Leenders, Arno
AU - Bostrom, PJ
AU - van der Aa, MNM (Madelon)
AU - Kakiashvili, DM
AU - Bangma VERVALLEN, CH
AU - Jewett, MAS
AU - Zlotta, AR
PY - 2012
Y1 - 2012
N2 - Background: Management of T1 bladder cancer (BCa) is controversial. Objective: Evaluate the impact of substage on the clinical outcome of T1 BCa. Design, setting, and participants: The T1 diagnosis of 134 first-diagnosis BCa patients from two university hospitals was confirmed. For the T1 substage, we used a new system that discerns T1-microinvasive (T1m) and T1-extensive-invasive (T1e) tumors. We then determined the invasion of the muscularis mucosae-vascular plexus (MM-VP): T1a (invasion above the MM-VP), T1b (invasion in the MM-VP), or T1c (invasion beyond the MM-VP). If the MM-VP was not present at the invasion front, the case was assigned to T1a or T1c. All patients were initially managed conservatively (with bacillus Calmette-Guerin). Measurements: Multivariable analyses for progression and disease-specific survival (DSS). Results and limitations: Median follow-up was 6.4 yr (interquartile range: 3.3-9.2 yr). Progression to >= T2 was observed in 40 patients (30%), and 19 patients (14%) died of BCa. The MM-VP was not present at the invasion front in 50 patients (37%). T1 substage was as follows: 40 T1m and 94 T1e; 81 T1a, 18 T1b, and 35 T1c. In multivariable analyses, substage (T1m/T1e) was significant for progression (p = 0.001) and DSS (p = 0.032), whereas substage according to T1a/T1b/T1c was not significant. Female gender (p = 0.006) and carcinoma in situ (p = 0.034) were also significant predictors of progression. Themainlimitation to the study is absence of a repeat transurethral resection. Conclusions: Substage according to the new system (T1m and T1e) was user-friendly, possible in 100% of cases, and very predictive of T1 BCa behavior. Future studies may ultimately lead to the incorporation of this new substaging system in the TNM classification system for urinary BCa. (C) 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
AB - Background: Management of T1 bladder cancer (BCa) is controversial. Objective: Evaluate the impact of substage on the clinical outcome of T1 BCa. Design, setting, and participants: The T1 diagnosis of 134 first-diagnosis BCa patients from two university hospitals was confirmed. For the T1 substage, we used a new system that discerns T1-microinvasive (T1m) and T1-extensive-invasive (T1e) tumors. We then determined the invasion of the muscularis mucosae-vascular plexus (MM-VP): T1a (invasion above the MM-VP), T1b (invasion in the MM-VP), or T1c (invasion beyond the MM-VP). If the MM-VP was not present at the invasion front, the case was assigned to T1a or T1c. All patients were initially managed conservatively (with bacillus Calmette-Guerin). Measurements: Multivariable analyses for progression and disease-specific survival (DSS). Results and limitations: Median follow-up was 6.4 yr (interquartile range: 3.3-9.2 yr). Progression to >= T2 was observed in 40 patients (30%), and 19 patients (14%) died of BCa. The MM-VP was not present at the invasion front in 50 patients (37%). T1 substage was as follows: 40 T1m and 94 T1e; 81 T1a, 18 T1b, and 35 T1c. In multivariable analyses, substage (T1m/T1e) was significant for progression (p = 0.001) and DSS (p = 0.032), whereas substage according to T1a/T1b/T1c was not significant. Female gender (p = 0.006) and carcinoma in situ (p = 0.034) were also significant predictors of progression. Themainlimitation to the study is absence of a repeat transurethral resection. Conclusions: Substage according to the new system (T1m and T1e) was user-friendly, possible in 100% of cases, and very predictive of T1 BCa behavior. Future studies may ultimately lead to the incorporation of this new substaging system in the TNM classification system for urinary BCa. (C) 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
U2 - 10.1016/j.eururo.2011.10.026
DO - 10.1016/j.eururo.2011.10.026
M3 - Article
VL - 61
SP - 378
EP - 384
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 2
ER -
