Department of Surgical Oncology, Division of Urology, University Health Network, Princess Margaret Hospital, Toronto, Canada.
Eur Urol. 2012 Feb;61(2):378-84. doi: 10.1016/j.eururo.2011.10.026. Epub 2011 Oct 25.
Management of T1 bladder cancer (BCa) is controversial.
Evaluate the impact of substage on the clinical outcome of T1 BCa.
DESIGN, SETTING, AND PARTICIPANTS: The T1 diagnosis of 134 first-diagnosis BCa patients from two university hospitals was confirmed. For the T1 substage, we used a new system that discerns T1-microinvasive (T1m) and T1-extensive-invasive (T1e) tumors. We then determined the invasion of the muscularis mucosae-vascular plexus (MM-VP): T1a (invasion above the MM-VP), T1b (invasion in the MM-VP), or T1c (invasion beyond the MM-VP). If the MM-VP was not present at the invasion front, the case was assigned to T1a or T1c. All patients were initially managed conservatively (with bacillus Calmette-Guérin).
Multivariable analyses for progression and disease-specific survival (DSS).
Median follow-up was 6.4 yr (interquartile range: 3.3-9.2 yr). Progression to ≥ T2 was observed in 40 patients (30%), and 19 patients (14%) died of BCa. The MM-VP was not present at the invasion front in 50 patients (37%). T1 substage was as follows: 40 T1m and 94 T1e; 81 T1a, 18 T1b, and 35 T1c. In multivariable analyses, substage (T1m/T1e) was significant for progression (p=0.001) and DSS (p=0.032), whereas substage according to T1a/T1b/T1c was not significant. Female gender (p=0.006) and carcinoma in situ (p=0.034) were also significant predictors of progression. The main limitation to the study is absence of a repeat transurethral resection.
Substage according to the new system (T1m and T1e) was user-friendly, possible in 100% of cases, and very predictive of T1 BCa behavior. Future studies may ultimately lead to the incorporation of this new substaging system in the TNM classification system for urinary BCa.
T1 膀胱癌（BCa）的治疗存在争议。
评估亚分期对 T1BCa 临床结局的影响。
设计、地点和参与者：对来自两家大学医院的 134 例初诊 BCa 患者的 T1 诊断进行了确认。对于 T1 亚分期，我们使用了一种新的系统，该系统可以区分 T1 微浸润（T1m）和 T1 广泛浸润（T1e）肿瘤。然后我们确定了黏膜下血管丛（MM-VP）的侵犯程度：T1a（侵犯 MM-VP 上方）、T1b（侵犯 MM-VP 内）或 T1c（侵犯 MM-VP 下方）。如果 MM-VP 不在侵犯前缘，病例则被分配到 T1a 或 T1c。所有患者最初均采用保守治疗（卡介苗）。
进展和疾病特异性生存（DSS）的多变量分析。
中位随访时间为 6.4 年（四分位距：3.3-9.2 年）。40 例患者（30%）进展为≥T2，19 例患者（14%）死于 BCa。50 例患者（37%）的 MM-VP 不在侵犯前缘。T1 亚分期如下：40 例 T1m 和 94 例 T1e；81 例 T1a、18 例 T1b 和 35 例 T1c。多变量分析显示，亚分期（T1m/T1e）与进展（p=0.001）和 DSS（p=0.032）显著相关，而根据 T1a/T1b/T1c 的亚分期不显著。女性（p=0.006）和原位癌（p=0.034）也是进展的显著预测因素。该研究的主要局限性是缺乏重复经尿道切除术。
根据新系统（T1m 和 T1e）进行的亚分期简单易用，100%的病例都可进行，并且对 T1BCa 的行为具有很好的预测性。未来的研究可能最终导致将这种新的亚分期系统纳入尿路上皮膀胱癌的 TNM 分类系统。
