Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 26;43(1):47.
doi: 10.1007/s00345-024-05410-6.

Oncological outcomes and prognostic implications of T1 histo-anatomic substaging in the management of high-Grade non-muscle invasive bladder cancer: results from a large single centre series

Marco Finati #  1   2 , Antonio Fanelli #  3 , Francesco Cinelli  3 , Nicola Schiavone  3 , Ugo Giovanni Falagario  3 , Anna Ricapito  3 , Nicola d'Altilia  3 , Richard Naspro  4 , Angelo Porreca  5 , Felice Crocetto  6 , Biagio Barone  6 , Ciro Imbimbo  6 , Carlo Bettocchi  3 , Francesca Sanguedolce  7 , Luigi Cormio  3   8 , Giuseppe Carrieri  3 , Gian Maria Busetto  3
Affiliations

Oncological outcomes and prognostic implications of T1 histo-anatomic substaging in the management of high-Grade non-muscle invasive bladder cancer: results from a large single centre series

Marco Finati et al. World J Urol. .

Abstract

Purpose: This study aimed to comprehensively evaluate the prognostic value of T1 histo-anatomic substaging (T1a/T1b) for high grade (HG) non-muscle invasive bladder cancer (NMIBC) over a large single-centre cohort.

Materials and methods: Patients with primary HG T1 NMIBC were identified from our Institutional database, between 2011 and 2022. Data from diagnosis to repeated transurethral resection of bladder tumour (RE-TURBT), bacillus Calmette-Guérin (BCG) treatment and follow-up were collected. Patients were stratified based on histo-anatomic landmark into T1a (invasion above the Muscularis Mucosa-MM) and T1b (into/beyond MM). Kaplan-Meier curves and multivariate Cox regression analyses were used to assess the impact of histo-anatomic substaging on recurrence-free survival (RFS), cancer-specific survival (CSS), and progression-free survival (PFS).

Results: Substaging was feasible in 88% of cases. The median (IQR) follow-up was 40 (17-72) months. T1b patients had larger initial tumours (> 3 cm: 43.2% vs. 26.1%, p < 0.001), while upstaging to muscle-invasive bladder cancer (MIBC) at RE-TURBT was more frequent in T1b than in T1a (5.9% vs. 1.5%, p = 0.02). T1b patients without BCG induction had worse RFS and PFS (all p ≤ 0.02) compared to T1a, while no differences were observed in patients who received complete BCG induction. At Multivariate analysis, completing at least a BCG induction course was associated with better outcomes across all endpoints.

Conclusions: Invasion of the MM in primary T1 NMIBC is associated with a higher risk of upstaging to MIBC. Patients who received full BCG induction had similar outcomes regardless of substaging, whereas T1b patients without BCG induction experienced higher recurrence and progression rates.

Keywords: BCG Vaccine; Non-muscle invasive bladder neoplasms; T1 substaging; Urinary bladder neoplasms.

PubMed Disclaimer

Conflict of interest statement

Declarations. IRB approval: Patients were retrospectively enrolled after this study was approved by IRB of Policlinico Riuniti of Foggia on 15th of March 2022 (Approval Code 31/CE/2022). An institutional review board waiver for informed consent was obtained prior to conducting this study, in accordance with institutional regulations when dealing with de-identified previously collected data. Conflict of interest: None of the authors have any relevant disclosures, and none of the authors have any financial or non-financial interests that may be relevant to the submitted work.

Similar articles

See all similar articles

References

    1. Siegel RL, Miller KD, Wagle NS, Jemal A (2023) Cancer statistics, 2023. CA Cancer J Clin 73(1):17–48. https://doi.org/10.3322/caac.21763 - DOI - PubMed
    1. Gontero P, Birtle A, Capoun O et al (2024) European Association of Urology Guidelines on non-muscle-invasive bladder Cancer (TaT1 and Carcinoma in Situ)-A Summary of the 2024 guidelines Update. Eur Urol. Published Online August 17(24):S0302–2838. https://doi.org/10.1016/j.eururo.2024.07.027 - DOI
    1. Compérat E, Larré S, Roupret M et al (2015) Clinicopathological characteristics of urothelial bladder cancer in patients less than 40 years old. Virchows Arch Int J Pathol 466(5):589–594. https://doi.org/10.1007/s00428-015-1739-2 - DOI
    1. Sylvester RJ, Rodríguez O, Hernández V et al (2021) European Association of Urology (EAU) prognostic factor risk groups for non-muscle-invasive bladder Cancer (NMIBC) incorporating the WHO 2004/2016 and WHO 1973 classification systems for Grade: an update from the EAU NMIBC guidelines Panel. Eur Urol 79(4):480–488. https://doi.org/10.1016/j.eururo.2020.12.033 - DOI - PubMed
    1. Cambier S, Sylvester RJ, Collette L et al (2016) EORTC nomograms and Risk groups for Predicting recurrence, progression, and Disease-specific and overall survival in Non-muscle-invasive Stage Ta-T1 urothelial bladder Cancer patients treated with 1–3 years of maintenance Bacillus Calmette-Guérin. Eur Urol 69(1):60–69. https://doi.org/10.1016/j.eururo.2015.06.045 - DOI - PubMed

LinkOut - more resources