Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Histopathology. 2024 Jul;85(1):92-103. doi: 10.1111/his.15177. Epub 2024 Mar 13.
We aimed to assess the oncological impact of micrometric extent of invasion in patients with pT1 bladder cancer (BCa) who underwent en-bloc resection for bladder tumour (ERBT).
We retrospectively analysed the records and specimens of 106 pT1 high-grade BCa patients who underwent ERBT. The extent of invasion, such as depth from basal membrane, number of invasive foci, maximum width of invasive focus, muscularis mucosae invasion and infiltration pattern (pattern A: solid sheet-like, nodular or nested growth, pattern B: trabecular, small cluster or single-cell pattern) were evaluated by a single genitourinary pathologist. The end-points were recurrence-free (RFS) and progression-free survival (PFS). Within a median follow-up of 23 months, overall, 36 patients experienced recurrence and 13 patients experienced disease progression. The 2-year PFS differed significantly depending on depth from basal membrane (< 1.3 mm: 94.8% versus ≧ 1.3 mm: 65.2%, P = 0.005), maximum width of invasive focus (< 4 mm: 91.7% versus ≧ 4 mm: 62.3%, P < 0.001), muscularis mucosae (MM) invasion (above MM = 96.1% versus into or beyond MM = 64.8%, P = 0.002) and infiltration pattern (pattern A: 100% versus pattern B: 83.3%, P = 0.037). In a multivariable analysis, MM invasion [hazard ratio (HR) = 4.54, 95% confidence interval (CI) = 1.25-16.5] and maximum width of invasive focus ≧ 4 mm (HR = 4.79, 95% CI = 1.25-16.5) were independent prognostic factors of progression.
En-bloc resection facilitates the evaluation of pathologic variables that might be useful in predicting disease recurrence and progression. In particular, not only the MM invasion but also the maximum width of invasion focus, reflecting the invasive volume, appear to be reliable prognosticators for disease progression.
我们旨在评估接受整块膀胱肿瘤切除术（ERBT）的 pT1 膀胱癌（BCa）患者肿瘤侵犯的微观程度对其的肿瘤学影响。
我们回顾性分析了 106 例接受 ERBT 的 pT1 高级别膀胱癌患者的记录和标本。由一名泌尿生殖系统病理学家评估肿瘤侵犯的程度，如从基底膜的深度、侵犯灶的数量、侵犯灶的最大宽度、黏膜肌层侵犯和浸润模式（模式 A：实性片状、结节状或巢状生长，模式 B：小梁状、小簇状或单细胞模式）。终点是无复发生存（RFS）和无进展生存（PFS）。在中位随访 23 个月内，总体而言，36 例患者出现复发，13 例患者出现疾病进展。2 年 PFS 与从基底膜的深度显著相关（<1.3mm：94.8%比≥1.3mm：65.2%，P=0.005）、侵犯灶的最大宽度（<4mm：91.7%比≥4mm：62.3%，P<0.001）、黏膜肌层侵犯（MM）（位于 MM 上方：96.1%比位于或超过 MM：64.8%，P=0.002）和浸润模式（模式 A：100%比模式 B：83.3%，P=0.037）。在多变量分析中，MM 侵犯[风险比（HR）=4.54，95%置信区间（CI）=1.25-16.5]和侵犯灶的最大宽度≥4mm（HR=4.79，95%CI=1.25-16.5）是疾病进展的独立预后因素。
整块切除术有利于评估可能有助于预测疾病复发和进展的病理变量。特别是，不仅 MM 侵犯，而且反映侵犯体积的侵犯灶的最大宽度似乎是疾病进展的可靠预后因素。
