Comparative Application of Different Substaging Techniques for Non-Muscle Invasive Urothelial Carcinoma
- 66 Downloads
To evaluate the diagnostic performance and clinical significance of 4 systems of substaging cases with non-muscle invasive urothelial bladder carcinoma. In addition 4 cutoff measures were evaluated for prediction of muscularis-mucosa invasion. Four substaging systems were applied to 57 NMIBC cases to assess which of these reported methods correlates best with recurrence and progression. On univariate regression analysis patients having tumor size more than 3 cm, solid tumor architecture, high grade, substage B, substage T1e, substage ROL 2 and Tumor depth more than 1 mm were associated with higher recurrence. On multivariate analysis all the four substaging systems, tumor size, grade and tumor type had significant prognostic value for recurrence. Regarding progression only the metric substaging method was associated with tumor progression (p = 0.04). However, on univariate and multivariate regression analysis none of the substaging systems showed prognostic significance and only solid tumor architecture and CIS had significant prognostic value for tumor progression. The ROC curve analysis showed that 1 mm depth of invasion had the best accuracy for detection of muscularis-mucosa invasion (80.2%). Using 1 mm cutoff in measuring the depth and 0.5 mm for the diameter of infiltration may provide clinically relevant information to guide a more personalized therapy for NMIBC. Inclusion of both measures in addition to other histopathologic variables may aid in the development of a scoring system.
KeywordsSubstaging Non-muscle invasive Urothelial carcinoma Urinary bladder
Compliance with Ethical Standards
Conflict of Interest
Authors declare no conflict of interest.
- 3.van de Putte EE F, Otto W, Hartmann A, Bertz S, Mayr R, Brundl J, Breyer J, Manach Q, Comperat EM, Boormans JL et al (2018) Metric substage according to micro and extensive lamina propria invasion improves prognostics in T1 bladder cancer. Urol Oncol 36(8):361e367–361e313Google Scholar
- 6.Otto W, van Rhijn BW, Breyer J, Bertz S, Eckstein M, Mayr R, Lausenmeyer EM, Denzinger S, Burger M, Hartmann A (2018) Infiltrative lamina propria invasion pattern as an independent predictor for cancer-specific and overall survival of instillation treatment-naive stage T1 high-grade urothelial bladder cancer. Int J Urol 25(5):442–449CrossRefGoogle Scholar
- 12.Leivo MZ, Sahoo D, Hamilton Z, Mirsadraei L, Shabaik A, Parsons JK, Kader AK, Derweesh I, Kane C, Hansel DE (2018) Analysis of T1 bladder Cancer on biopsy and transurethral resection specimens: comparison and ranking of T1 quantification approaches to predict progression to Muscularis Propria invasion. Am J Surg Pathol 42(1):e1–e10PubMedGoogle Scholar
- 13.Brimo F, Wu C, Zeizafoun N, Tanguay S, Aprikian A, Mansure JJ, Kassouf W (2013) Prognostic factors in T1 bladder urothelial carcinoma: the value of recording millimetric depth of invasion, diameter of invasive carcinoma, and muscularis mucosa invasion. Human Pathol 44(1):95–102CrossRefGoogle Scholar
- 18.Nishiyama N, Kitamura H, Maeda T, Takahashi S, Masumori N, Hasegawa T, Tsukamoto T (2013) Clinicopathological analysis of patients with non-muscle-invasive bladder cancer: prognostic value and clinical reliability of the 2004 WHO classification system. Jpn J Clin Oncol 43(11):1124–1131CrossRefGoogle Scholar
- 19.Bertz S, Denzinger S, Otto W, Wieland WF, Stoehr R, Hofstaedter F, Hartmann A (2011) 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. Histopathology 59(4):722–732CrossRefGoogle Scholar
- 20.Orsola A, Werner L, de Torres I, Martin-Doyle W, Raventos CX, Lozano F, Mullane SA, Leow JJ, Barletta JA, Bellmunt J et al (2015) Reexamining treatment of high-grade T1 bladder cancer according to depth of lamina propria invasion: a prospective trial of 200 patients. Br J Cancer 112(3):468–474CrossRefGoogle Scholar
- 22.Gontero P, Sylvester R, Pisano F, Joniau S, Vander Eeckt K, Serretta V, Larre S, Di Stasi S, Van Rhijn B, Witjes AJ et al (2015) Prognostic factors and risk groups in T1G3 non-muscle-invasive bladder cancer patients initially treated with Bacillus Calmette-Guerin: results of a retrospective multicenter study of 2451 patients. Eur Urol 67(1):74–82CrossRefGoogle Scholar