Department of Urology, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan.
Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
J Urol. 2021 Jun;205(6):1622-1628. doi: 10.1097/JU.0000000000001630. Epub 2021 Jan 27.
T1 bladder cancer is characterized by high recurrence and aggressive progression. Muscularis mucosae invasion may be a prognostic factor for progression, but the limitations of conventional transurethral resection of bladder tumors make diagnosis difficult. We correlated degree of invasion with oncologic outcome and evaluated the utility of pathological diagnosis following en bloc resection of bladder tumors.
We retrospectively analyzed the records of 123 consecutive patients diagnosed with pT1 bladder cancer between November 2013 and December 2018. Transurethral resection was conducted in 91 patients, and en bloc resection in 32 patients. All specimens were analyzed for invasion depth and pT1 substaging (T1a/b: invasion above or into/beyond muscularis mucosae, pT1m/e: microinvasive or extensively invasive). Primary end points were prognostic values of pT1 substaging and invasion depth. The secondary end point was the pathological diagnostic utility of en bloc resection.
Median followup was 23 months. Three-year progression-free survival rate differed significantly depending on muscularis mucosae invasion (pT1a: 97.3%, pT1b: 72.8%; p=0.003) and invasion depth from basal membrane (<2 mm: 90.6%, ≥2 mm: 77.9%; p=0.03). Multivariate analysis showed that sessile tumor and invasion depth from basal membrane ≥2 mm were independent prognostic factors for progression. Diagnostic rates for pT1a/b and invasion depth were 77.6% and 85.9%, respectively, with transurethral resection, but 100% and 100% with en bloc resection (p=0.01 and p=0.03).
Vertical lamina propria invasion is predictive of progression in T1 bladder cancer, underlining the importance of accurately diagnosing the degree of vertical lamina propria invasion with en bloc resection.
T1 膀胱癌的特点是高复发率和侵袭性进展。黏膜肌层浸润可能是进展的预后因素，但传统经尿道膀胱肿瘤切除术的局限性使得诊断困难。我们将浸润程度与肿瘤学结果相关联，并评估整块切除膀胱肿瘤后的病理诊断的效用。
我们回顾性分析了 2013 年 11 月至 2018 年 12 月连续 123 例诊断为 pT1 膀胱癌患者的记录。91 例行经尿道切除术，32 例行整块切除术。所有标本均分析浸润深度和 pT1 亚分期（T1a/b：黏膜肌层以上或进入/超越黏膜肌层，pT1m/e：微侵袭或广泛侵袭）。主要终点是 pT1 亚分期和浸润深度的预后价值。次要终点是整块切除的病理诊断效用。
中位随访时间为 23 个月。根据黏膜肌层浸润（pT1a：97.3%，pT1b：72.8%；p=0.003）和基底膜浸润深度（<2mm：90.6%，≥2mm：77.9%；p=0.03），三年无进展生存率有显著差异。多变量分析显示，基底膜浸润深度≥2mm 和基底膜浸润深度≥2mm 是进展的独立预后因素。经尿道切除术的 pT1a/b 和浸润深度的诊断率分别为 77.6%和 85.9%，而整块切除术的诊断率分别为 100%和 100%（p=0.01 和 p=0.03）。
垂直固有层浸润是 T1 膀胱癌进展的预测因素，强调了整块切除准确诊断垂直固有层浸润程度的重要性。
