Department of Pathology, Taipei Veterans General Hospital, Taiwan.
Am J Surg Pathol. 2012 Mar;36(3):454-61. doi: 10.1097/PAS.0b013e31823dafd3.
T1 papillary urothelial carcinomas of the urinary bladder run a variable clinical course, and an effective substaging system has not been defined yet. This study was conducted to devise an easy-to-use substaging method and to validate its prognostic value in T1 cancer on transurethral resection specimens. A total of 103 cases of T1 low-grade papillary urothelial carcinoma and 406 cases of T1 high-grade papillary urothelial carcinoma from a series of 1515 non-muscle-invasive bladder tumors treated by transurethral resection were studied. Substaging was performed using 0.5, 1.0, and 1.5 mm as thresholds to distinguish extensive from focal invasion. Correlations to recurrence, progression, cancer-specific mortality, and all-cause mortality were explored and compared with Ta tumors. All lamina propria invasions in low-grade papillary urothelial carcinomas were confined to 1.0 mm. The proportions of T1 high-grade papillary urothelial carcinoma invading beyond 0.5, 1.0 (T1>1 mm), and 1.5 mm were 53%, 32%, and 27%, respectively. No prognostic differences were found between Ta and T1 low-grade papillary urothelial carcinomas. T1>1 mm high-grade papillary urothelial carcinomas were associated with significantly greater risks for recurrence, progression, cancer-specific mortality, and all-cause mortality compared with T1≤1 mm and Ta tumors. Comparable statistical results could be obtained using 0.5 and 1.5 mm as cutoff points, but we recommend using 1.0 mm for practical consideration. Taking all non-muscle-invasive urothelial neoplasms of the bladder into consideration, 5 prognostically distinct categories can be established: (1) papillary urothelial neoplasms of low malignant potential; (2) low-grade papillary urothelial carcinoma Ta/1; (3) high-grade papillary urothelial carcinoma Ta; (4) high-grade papillary urothelial carcinoma T1≤1 mm; and (5) high-grade papillary urothelial carcinoma T1>1 mm. Our study demonstrates that the substaging of T1 bladder cancer is feasible, based on the evaluation of transurethral resection specimens, and can provide more precise prognostic information to identify a subset of patients with a more unfavorable prognosis.
T1 膀胱尿路上皮乳头状癌的临床病程存在差异,目前尚未确定有效的亚分期系统。本研究旨在设计一种易于使用的亚分期方法,并验证其在经尿道切除标本中 T1 癌的预后价值。该研究共纳入了 1515 例非肌肉浸润性膀胱癌经经尿道切除治疗的 103 例 T1 低级别乳头状尿路上皮癌和 406 例 T1 高级别乳头状尿路上皮癌患者。亚分期采用 0.5、1.0 和 1.5mm 作为阈值来区分广泛和局灶性浸润。探讨了与复发、进展、癌症特异性死亡率和全因死亡率的相关性,并与 Ta 肿瘤进行了比较。低级别乳头状尿路上皮癌的所有固有层浸润均局限于 1.0mm。T1 高级别乳头状尿路上皮癌侵犯超过 0.5、1.0(T1>1mm)和 1.5mm 的比例分别为 53%、32%和 27%。Ta 和 T1 低级别乳头状尿路上皮癌之间未发现预后差异。T1>1mm 高级别乳头状尿路上皮癌与 T1≤1mm 和 Ta 肿瘤相比,复发、进展、癌症特异性死亡率和全因死亡率的风险显著增加。使用 0.5 和 1.5mm 作为截断点可以获得类似的统计学结果,但出于实际考虑,我们建议使用 1.0mm。考虑到所有非肌肉浸润性膀胱尿路上皮肿瘤,可以建立 5 个具有不同预后的类别:(1)低恶性潜能的乳头状尿路上皮肿瘤;(2)Ta/1 级低级别乳头状尿路上皮癌;(3)Ta 级高级别乳头状尿路上皮癌;(4)T1≤1mm 级高级别乳头状尿路上皮癌;(5)T1>1mm 级高级别乳头状尿路上皮癌。本研究表明,基于经尿道切除标本的评估,T1 膀胱癌的亚分期是可行的,可以提供更精确的预后信息,以确定预后较差的患者亚组。