Minardi Daniele, Milanese Giulio, Parri Gianni, Lacetera Vito, Muzzonigro Giovanni
Department of Clinic and Specialistic Sciences, Urology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona.
Arch Ital Urol Androl. 2016 Mar 31;88(1):13-6. doi: 10.4081/aiua.2016.1.13.
To evaluate the main factors which influence understaging in patients with T1G3 non-muscle invasive bladder cancer (NMIBC).
109 patients with T1/G3 underwent transurethral resection of bladder tumor (TURBT) and then radical cystectomy (RC) with pelvic lymph nodes dissection. A number of variables were considered when evaluating the detection of understaging. We considered the patients age and gender, as well as the size, number, location and morphology of their tumor. We also considered coexistence of bladder carcinoma in situ (CIS), microscopic vascular invasion and deep lamina propria invasion. The level of experience of the surgeon was also analyzed.
in RC samples muscle invasion, that is understaging, was detected in 74 (67.9%) patients, while 35 (32.1%) patients were appropriately staged. In these cohort of patients with high grade tumors, understaging was associated with deep lamina propria and microscopic vascular invasion, multiple tumors, tumor size > 6 cm, tumor location (trigone and dome), presence of residual tumor; age, gender, tumor morphology, CIS associated, and experience of urological surgeon were not associated with clinical understaging.
in our study, evaluating patients with high grade NMIBC at first TURBT, we identified some risk factors that need to be considered and that are able to increase the risk of understaging: deep lamina propria and microscopic vascular invasion, multiple tumors, tumor size > 6 cm, tumor location (trigone and dome), presence of residual tumor. When these risk factors are present, performing an early cystectomy, and not a re-TURBT, could lower the risk of worse pathological finding due to rapid disease progression of the high grade tumors, and can prolong survival.
评估影响T1G3非肌层浸润性膀胱癌（NMIBC）患者分期过低的主要因素。
109例T1/G3患者接受了经尿道膀胱肿瘤切除术（TURBT），随后进行了根治性膀胱切除术（RC）及盆腔淋巴结清扫术。评估分期过低的检测情况时考虑了多个变量。我们考虑了患者的年龄和性别，以及肿瘤的大小、数量、位置和形态。我们还考虑了原位膀胱癌（CIS）的共存、微小血管侵犯和深层固有层侵犯。同时分析了外科医生的经验水平。
在RC样本中，74例（67.9%）患者检测到肌层浸润，即分期过低，而35例（32.1%）患者分期正确。在这些高级别肿瘤患者队列中，分期过低与深层固有层和微小血管侵犯、多发肿瘤、肿瘤大小>6 cm、肿瘤位置（三角区和穹窿部）、残留肿瘤的存在有关；年龄、性别、肿瘤形态、CIS相关性以及泌尿外科医生的经验与临床分期过低无关。
在我们的研究中，对首次接受TURBT的高级别NMIBC患者进行评估时，我们确定了一些需要考虑的风险因素，这些因素会增加分期过低的风险：深层固有层和微小血管侵犯、多发肿瘤、肿瘤大小>6 cm、肿瘤位置（三角区和穹窿部）、残留肿瘤的存在。当存在这些风险因素时，早期进行膀胱切除术而非再次TURBT，可降低因高级别肿瘤疾病快速进展导致更差病理结果的风险，并可延长生存期。
