分析微分级系统在预测 pT1 高级别非肌肉浸润性膀胱癌患者复发和进展中的应用。

Analysis of the Application of the Micrometric Substaging System to Predict Recurrence and Progression in a Cohort of Patients with pT1 High-Grade Non-Muscle Invasive Bladder Cancer.

机构信息

Department of Urology, ASST Fatebenefratelli-Sacco Hospitals, 20157 Milan, Italy.

Department of Urology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy.

出版信息

Arch Esp Urol. 2024 Sep;77(8):843-849. doi: 10.56434/j.arch.esp.urol.20247708.119.

DOI:10.56434/j.arch.esp.urol.20247708.119

PMID:39385478

Abstract

BACKGROUND

The World Health Organization (WHO) classification system for bladder cancer (BC) advocates for the substaging of pT1 disease, which may improve the prediction of cancer recurrence and progression. This study aims to evaluate the application and prognostic significance of a micrometric substaging system, utilising a 1 mm cut-off depth of invasion in patients with pT1 BC.

METHODS

We retrospectively reviewed all patients diagnosed with pT1 High-Grade Non-Muscle Invasive Bladder Cancer (NMIBC) at our institution. Lamina propria infiltration was categorised using a 1 mm cut-off to differentiate between Focal (<1 mm) or Extended (≥1 mm) disease, dividing the patients into Focal and Extended groups.

RESULTS

The study included 114 patients, with a median (Interquartile Range (IQR)) age of 78 (71-87) and a Charlson Comorbidity Index (CCI) of 6 (5-7). The median follow-up was 33 (20-53) months. Of these, 56 patients (49.0%) were classified as having focal invasive, while 58 (51.0%) had Extended invasion. Demographic and pathological characteristics were evenly distributed between the two groups without significant differences ( > 0.05). However, Extended disease was more prevalent at initial diagnosis (Odds Ratio (OR) 5.44, = 0.003). Multivariate analysis identified a first diagnosis of BC, pathological Grade 3 (G3), presence of (CIS) and residual tumour at second resection as independent predictors of Extended pT1. Recurrence rates, progression rates and cancer-specific mortality were 41.2%, 5.3% and 1.8%, respectively. There were no statistically significant differences between the Focal and Extended groups in 3-year recurrence-free (58.9% vs 63.8%, = 0.654), progression-free (92.9% vs 96.5%, = 0.270) and cancer-specific survival (100% vs 98.3%, = 0.425) rates.

CONCLUSIONS

In this retrospective, single-centre study, substaging by depth of invasion did not predict recurrence, progression or cancer-specific mortality in patients with pT1 NMIBC. The initial diagnosis of pT1 BC, presence of G3, CIS and residual tumour at the second resection were identified as independent predictors of Extended pT1.

摘要

背景

世界卫生组织（WHO）的膀胱癌（BC）分类系统提倡对 pT1 疾病进行亚分期，这可能有助于提高癌症复发和进展的预测能力。本研究旨在评估利用 pT1 BC 浸润深度 1mm 作为截断值的微观亚分期系统的应用和预后意义。

方法

我们回顾性分析了在我院诊断为 pT1 高级别非肌肉浸润性膀胱癌（NMIBC）的所有患者。采用 1mm 作为截断值，将固有层浸润分为局限性（＜1mm）或广泛性（≥1mm）疾病，将患者分为局限性和广泛性两组。

结果

该研究纳入了 114 例患者，中位（四分位间距（IQR））年龄为 78（71-87）岁，Charlson 合并症指数（CCI）为 6（5-7）分。中位随访时间为 33（20-53）个月。其中，56 例（49.0%）患者为局限性浸润，58 例（51.0%）患者为广泛性浸润。两组患者的人口统计学和病理学特征分布均匀，无显著差异（＞0.05）。然而，广泛性疾病在初始诊断时更为常见（优势比（OR）5.44， = 0.003）。多变量分析显示，BC 的初次诊断、病理分级 3（G3）、存在原位癌（CIS）和第二次切除时的肿瘤残留是 pT1 广泛性的独立预测因素。复发率、进展率和癌症特异性死亡率分别为 41.2%、5.3%和 1.8%。局限性和广泛性两组患者在 3 年无复发生存率（58.9%vs63.8%， = 0.654）、无进展生存率（92.9%vs96.5%， = 0.270）和癌症特异性生存率（100%vs98.3%， = 0.425）方面无统计学差异。