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Comparative Study
. 2016 Jan 20:11:6.
doi: 10.1186/s13000-016-0466-6.

Usefulness of pT1 substaging in papillary urothelial bladder carcinoma

Carlo Patriarca  1 , Rodolfo Hurle  2 , Marco Moschini  3 , Massimo Freschi  4 , Piergiuseppe Colombo  5 , Maurizio Colecchia  6 , Lucia Ferrari  7 , Giorgio Guazzoni  8 , Andrea Conti  9 , Giario Conti  10 , Roberta Lucianò  11 , Tiziana Magnani  12 , Renzo Colombo  13
Affiliations
Comparative Study

Usefulness of pT1 substaging in papillary urothelial bladder carcinoma

Carlo Patriarca et al. Diagn Pathol. .

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.

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.

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Figures

Fig. 1
Fig. 1
Lamina propria invasion in a high-grade papillary urothelial carcinoma: T1m/ROL1 substaging (T1 < 0.5 mm)
Fig. 2
Fig. 2
Lamina propria invasion in a high-grade papillary urothelial carcinoma: T1e/ROL1 substaging (the focus is contained within one x 200 field, although it is larger than one x400 field)
Fig. 3
Fig. 3
Multiple foci of lamina propria invasion in a high-grade papillary urothelial carcinoma: T1e/ROL2 substaging (multifocality of invasion cumulatively amounting to more than 1 mm, i.e. > 200x field)
Fig. 4
Fig. 4
Recurrence-free survival was significantly better (p < 0.001) in the group that underwent reTUR
Fig. 5
Fig. 5
No significant correlations between the three substaging systems and the recurrence-free rate on Kaplan Meier estimates
Fig. 6
Fig. 6
Progression-free rate: ROL substaging shows a significant correlation with progression in the Kaplan Meier estimates
Fig. 7
Fig. 7
None of the three methods were able to predict progression in the group of 64 cases not treated with reTUR
Fig. 8
Fig. 8
Progression-free rate: ROL substaging shows a significant correlation with progression in the Kaplan Meier estimates for the 250 cases treated with reTUR
See this image and copyright information in PMC

Comment in

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