Academic Departments of Urology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
J Urol. 2013 Jun;189(6):2069-76. doi: 10.1016/j.juro.2012.11.120. Epub 2012 Nov 28.
Predictive factors of T1 nonmuscle invasive bladder cancer evolution that could guide treatment decision making are lacking. We assessed the prognostic value of muscularis mucosa invasion in nonmuscle invasive bladder cancer.
In a national multicenter study patients with primary T1 nonmuscle invasive bladder cancer were recruited from 6 French hospitals. All patients had undergone transurethral resection of bladder tumor. All T1 tumors were substaged according to muscularis mucosa invasion as T1a-no invasion beyond the muscularis mucosa or T1b-invasion beyond the muscularis mucosa with muscle preservation. Subsequent central pathology review was then done by a single referent uropathologist. Muscularis mucosa invasion was tested as a prognostic factor for survival on univariate and multivariate analysis.
A total of 587 patients were enrolled in the study, including 388 (66%) with T1a and 199 (34%) with T1b tumors. Median followup after transurethral resection of bladder tumor was 35 months (IQR 14-54). There was no significant difference between groups T1a and T1b except high tumor grade in T1b cases (p <0.0001). After central review, initial pathological substaging was confirmed in 84% of cases. On multivariate analysis muscularis mucosa invasion (T1b substage) was significantly associated with recurrence-free (p = 0.03), progression-free (p = 0.0002) and cancer specific (p = 0.02) survival. The main study limitation was absent systematic subsequent transurethral resection of bladder tumor.
Muscularis mucosa invasion appears to be highly predictive of T1 nonmuscle invasive bladder cancer behavior. Consequently, systematic T1a vs T1b discrimination should be highly advocated by urologists and pathologists. We believe that it could aid in crucial decision making when choosing between conservative management and radical cystectomy remains a moot point.
缺乏能够指导治疗决策的 T1 非肌肉浸润性膀胱癌演变的预测因素。我们评估了肌层黏膜浸润在非肌肉浸润性膀胱癌中的预后价值。
在一项全国性多中心研究中，从法国 6 家医院招募了原发性 T1 非肌肉浸润性膀胱癌患者。所有患者均接受了经尿道膀胱肿瘤切除术。所有 T1 肿瘤均根据肌层黏膜浸润情况进行亚分期，分为 T1a-黏膜肌层无浸润或 T1b-黏膜肌层浸润伴肌肉保留。随后由一名参考泌尿科病理学家对所有 T1 肿瘤进行中心病理复查。在单变量和多变量分析中，肌层黏膜浸润被测试为生存的预后因素。
共有 587 例患者入组研究，其中 388 例（66%）为 T1a 肿瘤，199 例（34%）为 T1b 肿瘤。经尿道膀胱肿瘤切除术的中位随访时间为 35 个月（IQR 14-54）。T1a 组和 T1b 组之间除 T1b 病例中高肿瘤分级外（p<0.0001），无显著差异。经过中心复查，84%的病例初始病理分期得到确认。多变量分析显示，肌层黏膜浸润（T1b 亚期）与无复发生存（p=0.03）、无进展生存（p=0.0002）和癌症特异性生存（p=0.02）显著相关。主要研究局限性在于缺乏系统的后续经尿道膀胱肿瘤切除术。
肌层黏膜浸润似乎高度预测 T1 非肌肉浸润性膀胱癌的行为。因此，泌尿科医生和病理学家应强烈提倡系统地对 T1a 与 T1b 进行区分。我们认为，在选择保守治疗与根治性膀胱切除术之间，这有助于做出关键决策，尽管后者仍存在争议。
