Stalk versus base invasion in pT1 papillary cancers of the bladder: improved substaging system predicting the risk of progression.

Pathological stage pT1 bladder cancers constitute a clinically heterogeneous group. However, current staging guidelines for superficially invasive cancers do not acknowledge the variability in type and extent of lamina propria invasion in papillary urothelial carcinomas (PUCs), and historically proposed substaging systems showed either high interobserver variation or limited value in predicting patient outcomes. The aim of this study was to reappraise pT1 PUC substaging, with the objective of identifying a novel scheme that is reproducible and prognostically meaningful. pT1 PUCs diagnosed during 1999-2015 were retrospectively reviewed and characterized as focal invasion confined to the papillary stalk, focal invasion of the tumour base, or extensive invasion of the tumour base. Cases with concurrent flat carcinoma in situ, angiolymphatic invasion, absent muscularis propria or clinically advanced disease were excluded. We calculated cumulative incidence rates of recurrence, progression and death by tumour subtype, and evaluated differential risks by using log-rank tests and Kaplan-Meier curves stratified by type and extent of invasion. Among 62 patients satisfying the inclusion criteria, 22 of 29 patients with base-extensive invasion progressed, whereas four of 13 with base-focal and none of 20 with stalk-only invasion progressed. There was strong evidence that base-extensive patients had a higher risk of progression and death resulting from bladder cancer than base-focal or stalk-only patients (P < 0.0001). However, tumour subtype was not significantly associated with risk of recurrence (P = 0.21). We propose an innovative substaging approach for reporting the site and extent of lamina propria invasion in patients with pT1 PUC, allowing patient stratification for risk of progression.

Lawless M ，Gulati R ，Tretiakova M 《-》

Substaging by estimating the size of invasive tumour can improve risk stratification in pT1 urothelial bladder cancer-evaluation of a large hospital-based single-centre series.

The outcome of patients with pT1 bladder cancer cannot yet be reliably estimated. The aim of this study was to evaluate several parameters in one of the largest series of initial pT1 bladder cancers. Specimens of 309 patients with pT1 urothelial carcinoma were re-evaluated histologically, including size of infiltrating tumour area estimated as equal to or smaller than one high-power field (HPF) or larger than one HPF, and tumour infiltration in relation to the muscularis mucosae (pT1a/b). Results were correlated with clinical follow-up. Substaging by HPF was associated with tumour recurrence, progression and survival in univariate analysis, and with recurrence and progression in multivariate analysis. According to the World Health Organization (WHO) 1973 grading, 220 tumours were G3, 89 were G2, and none was G1. Tumour grading was an independent prognostic marker of survival. Substaging by HPF revealed G2 and G3 tumours as distinct prognostic groups with regard to recurrence and progression. No significance was found for substaging pT1a/pT1b. An infiltrative growth pattern was significantly correlated with progression and survival in univariate analysis. Comparison of two systems of substaging pT1 bladder cancer shows that measurement of the size of infiltrating tumour area by HPFs may improve risk stratification. An infiltrative growth pattern on the invasion front should be documented in the pathological report, indicating a worse outcome. Additional studies are needed to find further parameters detecting high-risk tumours.

Bertz S ，Denzinger S ，Otto W ，Wieland WF ，Stoehr R ，Hofstaedter F ，Hartmann A ... -  《-》

Prognostic significance in substaging ofT1 urinary bladder urothelial carcinoma on transurethral resection.

Chang WC ，Chang YH ，Pan CC 《-》

Usefulness of pT1 substaging in papillary urothelial bladder carcinoma.

Patriarca C ，Hurle R ，Moschini M ，Freschi M ，Colombo P ，Colecchia M ，Ferrari L ，Guazzoni G ，Conti A ，Conti G ，Lucianò R ，Magnani T ，Colombo R ... -  《Diagnostic Pathology》

Substaging of pT1 Urothelial Bladder Carcinoma Predicts Tumor Progression and Overall Survival.

Limitations in tumor staging and the heterogeneous natural evolution of pT1 urothelial bladder carcinoma (UBC) make the choice of treatment challenging. We evaluated if histopathological substaging (pT1a, pT1b, and pT1c) helps predict disease recurrence, progression, and overall survival following transurethral resection of the bladder (TURB). We included 239 consecutive patients diagnosed with pT1 UBC at TURB in a single institution since 2001. Each sample was interpreted by our specialized uropathologists trained to subclassify pT1 stage. Three groups were distinguished according to the degree of invasion: T1a (up to the muscularis mucosae [MM]), T1b (into the MM), and T1c (beyond the MM). T1 substaging was possible in 217/239 (90%) patients. pT1a, b, and c occurred in 124 (57), 59 (27), and 34 (16%), respectively. The median follow-up was 3.1 years, with a cumulative recurrence rate of 52%, progression rate of 20%, and survival rate of 54%. Recurrence was not significantly associated with tumor substage (p = 0.61). However, the Kaplan-Meier survival analysis showed a significantly higher progression rate among T1b (31) and T1c (26%) tumors than T1a (13%) (log-rank test: p = 0.001) stages. In a multivariable model including gender, age, ASA score, smoking, tumor grade, and presence of carcinoma in situ, T1 substage was the single variable significantly associated with progression-free survival (HR 1.7, p = 0.005). Nineteen patients (9%) needed radical cystectomy; among them, 12/19 (63%) had an invasive tumor. Overall survival was significantly associated with tumor substaging (p = 0.001). Histopathological substaging of pT1 UBC is significantly associated with tumor progression and overall survival and therefore appears to be a useful prognostic tool to counsel patients about treatment options.

Grobet-Jeandin E ，Wirth GJ ，Benamran D ，Dupont A ，Tille JC ，Iselin CE ... -  《-》