Beijert Irene J, Hentschel Anouk E, Bründl Johannes, Compérat Eva M, Plass Karin, Rodríguez Oscar, Subiela Henríquez Jose D, Hernández Virginia, de la Peña Enrique, Alemany Isabel, Turturica Diana, Pisano Francesca, Soria Francesco, Čapoun Otakar, Bauerová Lenka, Pešl Michael, Maxim Bruins H, Runneboom Willemien, Herdegen Sonja, Breyer Johannes, Brisuda Antonin, Calatrava Ana, Rubio-Briones José, Seles Maximilian, Mannweiler Sebastian, Bosschieter Judith, Kusuma Venkata R M, Ashabere David, Huebner Nicolai, Cotte Juliette, Mertens Laura S, Masson-Lecomte Alexandra, Liedberg Fredrik, Cohen Daniel, Lunelli Luca, Cussenot Olivier, El Sheikh Soha, Volanis Dimitrios, Côté Jean-François, Rouprêt Morgan, Haitel Andrea, Shariat Shahrokh F, Mostafid A Hugh, Nieuwenhuijzen Jakko A, Zigeuner Richard, Dominguez-Escrig Jose L, Hacek Jaromir, Zlotta Alexandre R, Burger Maximilian, Evert Matthias, Hulsbergen-van de Kaa Christina A, van der Heijden Antoine G, A L M Kiemeney Lambertus, Soukup Viktor, Molinaro Luca, Gontero Paolo, Llorente Carlos, Algaba Ferran, Palou Joan, N'Dow James, Ribal Maria J, van der Kwast Theo H, Babjuk Marko, Sylvester Richard J, van Rhijn Bas W G
Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.
Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
Eur Urol Focus. 2022 Nov;8(6):1627-1634. doi: 10.1016/j.euf.2022.04.014. Epub 2022 May 14.
The pathological existence and clinical consequence of stage T1 grade 1 (T1G1) bladder cancer are the subject of debate. Even though the diagnosis of T1G1 is controversial, several reports have consistently found a prevalence of 2-6% G1 in their T1 series. However, it remains unclear if T1G1 carcinomas have added value as a separate category to predict prognosis within the non-muscle-invasive bladder cancer (NMIBC) spectrum.
To evaluate the prognostic value of T1G1 carcinomas compared to TaG1 and T1G2 carcinomas within the NMIBC spectrum.
DESIGN, SETTING, AND PARTICIPANTS: Individual patient data for 5170 primary Ta and T1 bladder tumors from 17 hospitals in Europe and Canada were analyzed. Transurethral resection (TUR) was performed between 1990 and 2018.
Time to recurrence and progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox regression models stratified by institution.
T1G1 represented 1.9% (99/5170) of all carcinomas and 5.3% (99/1859) of T1 carcinomas. According to primary TUR dates, the proportion of T1G1 varied between 0.9% and 3.5% per year, with similar percentages in the early and later calendar years. We found no difference in time to recurrence between T1G1 and TaG1 (p = 0.91) or between T1G1 and T1G2 (p = 0.30). Time to progression significantly differed between TaG1 and T1G1 (p < 0.001) but not between T1G1 and T1G2 (p = 0.30). Multivariable analyses for recurrence and progression showed similar results.
The relative prevalence of T1G1 diagnosis was low and remained constant over the past three decades. Time to recurrence of T1G1 NMIBC was comparable to that for other stage/grade NMIBC combinations. Time to progression of T1G1 NMIBC was comparable to that for T1G2 but not for TaG1, suggesting that treatment and surveillance of T1G1 carcinomas should be more like the approaches for T1G2 NMIBC in accordance with the intermediate and/or high risk categories of the European Association of Urology NMIBC guidelines.
Although rare, stage T1 grade 1 (T1G1) bladder cancer is still diagnosed in daily clinical practice. Using individual patient data from 17 centers in Europe and Canada, we found that time to progression of T1G1 cancer was comparable to that for T1G2 but not TaG1 cancer. Therefore, our results suggest that primary T1G1 bladder cancers should be managed with more aggressive treatment and more frequent follow-up than for low-risk bladder cancer.
T1期1级（T1G1）膀胱癌的病理存在及临床后果存在争议。尽管T1G1的诊断存在争议，但几份报告一致发现其在T1期肿瘤系列中的患病率为2%-6%。然而，T1G1癌作为非肌层浸润性膀胱癌（NMIBC）范围内预测预后的一个单独类别是否具有附加价值仍不清楚。
评估在NMIBC范围内，与TaG1和T1G2癌相比，T1G1癌的预后价值。
设计、研究地点和参与者：分析了来自欧洲和加拿大17家医院的5170例原发性Ta和T1膀胱肿瘤的个体患者数据。经尿道切除术（TUR）于1990年至2018年间进行。
使用累积发病率函数、对数秩检验和按机构分层的多变量Cox回归模型分析复发和进展时间。
T1G1占所有癌的1.9%（99/5170），占T1期癌的5.3%（99/1859）。根据初次TUR日期，T1G1的比例每年在0.9%至3.5%之间变化，早期和后期历年的百分比相似。我们发现T1G1和TaG1之间的复发时间无差异（p = 0.91），T1G1和T1G2之间也无差异（p = 0.30）。TaG1和T1G1之间的进展时间有显著差异（p < 0.001），但T1G1和T1G2之间无差异（p = 0.30）。复发和进展的多变量分析显示了相似的结果。
T1G1诊断的相对患病率较低，在过去三十年中保持稳定。T1G1 NMIBC的复发时间与其他分期/分级的NMIBC组合相当。T1G1 NMIBC的进展时间与T1G2相当，但与TaG1不同，这表明根据欧洲泌尿外科学会NMIBC指南的中危和/或高危类别，T1G1癌的治疗和监测应更类似于T1G2 NMIBC的方法。
虽然罕见，但T1期1级（T1G1）膀胱癌仍在日常临床实践中被诊断出来。使用来自欧洲和加拿大17个中心的个体患者数据，我们发现T1G1癌的进展时间与T1G2癌相当，但与TaG1癌不同。因此，我们的结果表明，原发性T1G1膀胱癌应采用比低风险膀胱癌更积极的治疗和更频繁的随访。
