Asimakopoulos Anastasios D, Colalillo Gaia, Telesca Rossana, Mauriello Alessandro, Miano Roberto, Di Stasi Savino Mauro, Germani Stefano, Finazzi Agrò Enrico, Petrozza Vincenzo, Caruso Gianluca, Carbone Antonio, Pastore Antonio Luigi, Fuschi Andrea
Division of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy.
Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy.
Front Surg. 2021 Aug 23;8:704902. doi: 10.3389/fsurg.2021.704902. eCollection 2021.
The T1 substaging of bladder cancer (BCa) potentially impacts disease progression. The objective of the study was to compare the prognostic accuracy of two substaging systems on the recurrence and progression of primary pathologic T1 (pT1) BCa and to test a nomogram based on pT1 substaging for predicting recurrence-free survival (RFS) and progression-free survival (PFS). The medical records of 204 patients affected by pT1 BCa were retrospectively reviewed. Substaging was defined according to the depth of lamina propria invasion in T1 and the extension of the lamina propria invasion to T1-microinvasive (T1) or T1-extensive (T1). Uni- and multivariable Cox regression models evaluated the independent variables correlated with recurrence and progression. The predictive accuracies of the two substaging systems were compared by Harrell's C index. Multivariate Cox regression models for the RFS and PFS were also depicted by a nomogram. The 5-year RFS was 47.5% with a significant difference between T1 and T1 ( = 0.02) and between T1 and T1 ( < 0.001). The 5-year PFS was 75.9% with a significant difference between T1 and T1 ( = 0.011) and between T1 and T1 ( < 0.001). Model T1 showed a higher predictive power than T1 for predicting RFS and PFS. In the univariate and multivariate model subcategory T1e, the diameter, location, and number of tumors were confirmed as factors influencing recurrence and progression after adjusting for the other variables. The nomogram incorporating the T1 model showed a satisfactory agreement between model predictions at 5 years and actual observations. Substaging is significantly associated with RFS and PFS for patients affected by T1 BCa and should be included in innovative prognostic nomograms.
膀胱癌（BCa）的T1亚分期可能影响疾病进展。本研究的目的是比较两种亚分期系统对原发性病理T1（pT1）BCa复发和进展的预后准确性，并测试基于pT1亚分期的列线图以预测无复发生存期（RFS）和无进展生存期（PFS）。对204例pT1 BCa患者的病历进行了回顾性分析。亚分期根据T1期固有层浸润深度以及固有层浸润扩展至T1微浸润（T1）或T1广泛浸润（T1）来定义。单变量和多变量Cox回归模型评估与复发和进展相关的独立变量。通过Harrell's C指数比较两种亚分期系统的预测准确性。RFS和PFS的多变量Cox回归模型也用列线图表示。5年RFS为47.5%，T1与T1之间有显著差异（=0.02），T1与T1之间有显著差异（<0.001）。5年PFS为75.9%，T1与T1之间有显著差异（=0.011），T1与T1之间有显著差异（<0.001）。模型T1在预测RFS和PFS方面显示出比T1更高的预测能力。在单变量和多变量模型亚类别T1e中，在调整其他变量后，肿瘤的直径、位置和数量被确认为影响复发和进展的因素。纳入T1模型的列线图在5年时模型预测与实际观察之间显示出令人满意的一致性。对于pT1 BCa患者，亚分期与RFS和PFS显著相关，应纳入创新的预后列线图中。
