En bloc resection improves the identification of muscularis mucosae in non-muscle invasive bladder cancer
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The T1 substage, according to the relationship between muscularis mucosae (MM) and tumors, is a promising prognostic factor for T1 bladder cancer. However, the identification rate of MM is low in specimens, and it is, therefore, not widely used in clinical practice. In this study, we investigated whether en bloc resection of non-muscle invasive bladder cancer (NMIBC) could improve the identification of muscularis mucosae (MM), which may further accurate identification of the T1 substage.
Patients and methods
Specimens from 158 patients with primary NMIBC were retrospectively reviewed by two independent pathologists to assess the presence of MM and stratify the T1 substage. Of 158 specimens, 70 specimens were obtained via TURBt with a plasma kinetic loop and 88 were obtained via front-firing potassium-titanyl-phosphate (KTP) green-light laser en bloc resection. Univariable and multivariable logistic regression models were used to analyze the relationship between the clinical characteristics and the presence of MM.
The mean age was 58.22 years (range 18–85 years). Multivariable logistic regression analysis showed that the KTP laser resection method was associated with the presence of MM in specimens (P = 0.008). In addition, tumors with smaller sizes, which could also be en bloc resected with TURBt (e.g., ≤1 cm), had a higher presence of MM (P = 0.047).
En bloc resection improves the identification rate of MM, which may enhance the accurate identification of the T1 substage.
KeywordsT1 substage En bloc resection Muscularis mucosae Non-muscle invasive bladder cancer
This study was supported by the National Natural Science Foundation of China (No: 81572520) and the Clinical Research Award of the First Affiliated Hospital of Xi'an Jiaotong University, China (No: XJTU1AF–CRF-2015–002 to DH) and International cooperation project of Shanxi, China (No: S2016YFKW0042). The authors appreciate Prof. Guanjun Zhang, from the Department of Pathology, the First Affiliated Hospital of Xi’an Jiaotong University, for help in this paper.
JHF: perform operation, project development, and manuscript editing. HL: data collection, manuscript writing, view pathological specimens. TY: data collection and manuscript writing. KJW: project development and manuscript writing. DLH: manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study, formal consent is not required.
- 2.Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, Newling DW, Kurth K (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 596 patients from seven EORTC trials. Eur Urol 49:465–466 (475–477)CrossRefGoogle Scholar
- 3.Xylinas E, Kent M, Kluth L, Pycha A, Comploj E, Svatek RS, Lotan Y, Trinh QD, Karakiewicz PI, Holmang S et al (2013) Accuracy of the EORTC risk tables and of the CUETO scoring model to predict outcomes in non-muscle-invasive urothelial carcinoma of the bladder. Br J Cancer 109:1460–1466CrossRefGoogle Scholar
- 14.Colombo R, Hurle R, Moschini M, Freschi M, Colombo P, Colecchia M, Ferrari L, Luciano R, Conti G, Magnani T et al (2016) Feasibility and Clinical Roles of Different Substaging Systems at First and Second Transurethral Resection in Patients with T1 High-Grade Bladder Cancer. Eur Urol Focus 4(1):87–93CrossRefGoogle Scholar
- 16.Karl A, Herrmann TR (2015) En bloc resection of urothelial cancer within the urinary bladder: the upcoming gold standard? : Re: Kramer MW, Wolters M, Cash H, Jutzi S, Imkamp F, Kuczyk MA, Merseburger AS, Herrmann TR. Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014. World J Urol. 2014 Jun 10. [Epub ahead of print]. https://doi.org/10.1007/s00345-014-1337-y. World J Urol 33: 581–582CrossRefGoogle Scholar
- 17.Chen J, Zhao Y, Wang S, Jin X, Sun P, Zhang L, Wang M (2016) Green-light laser en bloc resection for primary non-muscle-invasive bladder tumor versus transurethral electroresection: a prospective, nonrandomized two-center trial with 36-month follow-up. Lasers Surg Med 48:859–865CrossRefGoogle Scholar