Yasui Masato, Ohta Jun-Ichi, Aoki Shuntaro, Tajirika Hironao, Terao Hideyuki, Funahashi Makoto, Moriyama Masatoshi, Hayashi Hiroyuki
Department of Urology, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan.
Department of Pathology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
Int Urol Nephrol. 2021 Jun;53(6):1105-1109. doi: 10.1007/s11255-020-02772-9. Epub 2021 Jan 2.
To evaluate the prognosis of patients with pT1 bladder cancer who underwent en bloc resection of bladder tumors (ERBTs), stratified by invasion to the muscularis mucosa (MM) level.
Among 64 specimens obtained by ERBT with bipolar energy from patients with pT1 bladder cancer, MM was detected in 61 specimens. Thus, 61 specimens were included in this retrospective study. Patients were stratified by invasion to the MM level (pT1a, invasion above the MM level; pT1b, invasion within the MM level; and pT1c, invasion beyond the MM level). In specimens with discontinuous MM, invasion to the MM level was predicted from the dispersed MM in the specimen. The primary endpoints were progression-free survival (PFS) and cancer-specific survival (CSS).
Progression occurred in 2/39 patients with pT1a (5.1%), 1/6 patients with pT1b (16.7%), and 6/16 patients with pT1c cancer (37.5%). Cancer death occurred in 1/39 patients with pT1a (2.6%), 0/7 patients with pT1b, and 3/16 patients with pT1c cancer (18.8%). Patients with pT1a or pT1b cancer had a significantly better prognosis than those with pT1c cancer. On univariate analysis, tumor size ≥ 3 cm and pT1c were significantly associated with shorter PFS. On multivariate analysis, only pT1c was independently associated with shorter PFS.
This is the first study evaluating the prognosis by T1 substaging based on invasion to the MM level using ERBT specimens. ERBT provided high-quality specimens for diagnosing the MM and showed poor prognosis in pT1c bladder cancer. ERBT could be an appropriate surgical approach for an accurate diagnosis and prognosis of the T1 bladder cancer substage.
评估接受膀胱肿瘤整块切除术（ERBT）的pT1期膀胱癌患者的预后，并根据肌层黏膜（MM）浸润程度进行分层。
在64例通过双极能量进行ERBT获取的pT1期膀胱癌患者标本中，61例标本检测到MM。因此，本回顾性研究纳入61例标本。患者根据MM浸润程度分层（pT1a，浸润至MM水平以上；pT1b，浸润于MM水平内；pT1c，浸润超过MM水平）。在MM不连续的标本中，根据标本中分散的MM预测MM浸润程度。主要终点为无进展生存期（PFS）和癌症特异性生存期（CSS）。
39例pT1a患者中有2例（5.1%）发生进展，6例pT1b患者中有1例（16.7%）发生进展，16例pT1c癌症患者中有6例（37.5%）发生进展。39例pT1a患者中有1例（2.6%）死于癌症，7例pT1b患者中0例，16例pT1c癌症患者中有3例（18.8%）死于癌症。pT1a或pT1b癌症患者的预后明显优于pT1c癌症患者。单因素分析显示，肿瘤大小≥3 cm和pT1c与较短的PFS显著相关。多因素分析显示，只有pT1c与较短的PFS独立相关。
这是第一项使用ERBT标本根据MM浸润程度对T1期进行亚分期来评估预后的研究。ERBT为诊断MM提供了高质量标本，且显示pT1c期膀胱癌预后较差。ERBT可能是准确诊断和判断T1期膀胱癌亚分期预后的合适手术方法。
