Division of Oncology/Urology, Urological Research Institute, IRCCS, Ospedale S. Raffaele, Milan, Italy.
Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Milan, Italy.
Eur Urol Focus. 2018 Jan;4(1):87-93. doi: 10.1016/j.euf.2016.06.004. Epub 2016 Jun 15.
Decision making in T1 high-grade bladder cancer patients remains a challenging issue in urologic practice.
To assess the feasibility and potential prognostic role of three different substaging systems in specimens from both primary and second transurethral resection (TUR) of the bladder in T1 high-grade bladder cancer patients.
DESIGN, SETTING, AND PARTICIPANTS: A total of 250 consecutive, confirmed pure transitional T1 high-grade bladder tumors submitted to second TUR entered the retrospective study.
Feasibility of two already clinically tested microstaging systems (anatomy-based T1a/T1b/T1c and micrometric T1m/T1e with 0.5-mm thresholds of invasion) and that of a micrometric substage designed by the authors and based on a 1-mm threshold of invasion (Rete Oncologica Lombarda [ROL] system) was assessed by five independent uropathologists on both first and second TUR specimens. Univariable Cox proportional hazards models were attempted to identify significant independent predictors of recurrence and progression after TUR. Kaplan-Meier curves were plotted to compare different substaging methods analyzing recurrence and progression.
The ROL system proved to be feasible in nearly all cases at both first and second TUR. Median follow-up was 60 mo. The univariate Cox regression analysis documented the ROL substage (ROL2 vs ROL1) to be the only statistically significant predictor of progression (hazard ratio: 2.01; 95% CI, 1.03-3.79; p<0.03). For the first time to our knowledge, the substage was investigated and used to assess T1 tumors found at second TUR, registering a high rate of feasibility.
T1 microstaging using different procedures is feasible on both primary- and second-TUR specimens. A high rate of feasibility may be expected for T1m/T1e and ROL systems. The clinical role of microstaging on second TUR remains to be defined.
The Rete Oncologica Lombarda system showed feasible results in T1 high-grade bladder tumors. Our substratification was predictive of progression of disease.
在泌尿科实践中，T1 高级别膀胱癌患者的决策仍然是一个具有挑战性的问题。
评估三种不同亚分期系统在 T1 高级别膀胱癌患者的原发和二次经尿道切除（TUR）标本中的可行性和潜在预后作用。
设计、设置和参与者：共有 250 例连续、确诊的纯移行性 T1 高级别膀胱癌患者接受了第二次 TUR，进入了回顾性研究。
由五位独立的泌尿科病理学家评估了两种已临床测试的微分期系统（基于解剖的 T1a/T1b/T1c 和微尺度 T1m/T1e，侵袭深度为 0.5mm 阈值）和作者设计的基于 1mm 侵袭深度阈值的微分期（伦巴第肿瘤网络 [ROL] 系统）在第一次和第二次 TUR 标本上的可行性。尝试使用单变量 Cox 比例风险模型确定 TUR 后复发和进展的显著独立预测因素。绘制 Kaplan-Meier 曲线比较不同亚分期方法分析复发和进展。
ROL 系统在第一次和第二次 TUR 中几乎所有病例中都证明是可行的。中位随访时间为 60 个月。单变量 Cox 回归分析记录 ROL 分期（ROL2 与 ROL1）是进展的唯一统计学显著预测因素（风险比：2.01；95%置信区间，1.03-3.79；p<0.03）。据我们所知，这是首次调查和使用亚分期来评估第二次 TUR 中发现的 T1 肿瘤，其可行性很高。
使用不同方法进行 T1 微分期在原发性和第二次 TUR 标本中都是可行的。T1m/T1e 和 ROL 系统的可行性可能很高。微分期在第二次 TUR 中的临床作用仍有待确定。
ROL 系统在 T1 高级别膀胱癌中显示出可行的结果。我们的亚分层预测了疾病的进展。
