Finati Marco, Fanelli Antonio, Cinelli Francesco, Schiavone Nicola, Falagario Ugo Giovanni, Ricapito Anna, d'Altilia Nicola, Naspro Richard, Porreca Angelo, Crocetto Felice, Barone Biagio, Imbimbo Ciro, Bettocchi Carlo, Sanguedolce Francesca, Cormio Luigi, Carrieri Giuseppe, Busetto Gian Maria
Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.
Department of Urology and Renal Transplantation, University of Foggia, Viale Luigi Pinto 1, Foggia, 71121, Italy.
World J Urol. 2024 Dec 26;43(1):47. doi: 10.1007/s00345-024-05410-6.
This study aimed to comprehensively evaluate the prognostic value of T1 histo-anatomic substaging (T1a/T1b) for high grade (HG) non-muscle invasive bladder cancer (NMIBC) over a large single-centre cohort.
Patients with primary HG T1 NMIBC were identified from our Institutional database, between 2011 and 2022. Data from diagnosis to repeated transurethral resection of bladder tumour (RE-TURBT), bacillus Calmette-Guérin (BCG) treatment and follow-up were collected. Patients were stratified based on histo-anatomic landmark into T1a (invasion above the Muscularis Mucosa-MM) and T1b (into/beyond MM). Kaplan-Meier curves and multivariate Cox regression analyses were used to assess the impact of histo-anatomic substaging on recurrence-free survival (RFS), cancer-specific survival (CSS), and progression-free survival (PFS).
Substaging was feasible in 88% of cases. The median (IQR) follow-up was 40 (17-72) months. T1b patients had larger initial tumours (> 3 cm: 43.2% vs. 26.1%, p < 0.001), while upstaging to muscle-invasive bladder cancer (MIBC) at RE-TURBT was more frequent in T1b than in T1a (5.9% vs. 1.5%, p = 0.02). T1b patients without BCG induction had worse RFS and PFS (all p ≤ 0.02) compared to T1a, while no differences were observed in patients who received complete BCG induction. At Multivariate analysis, completing at least a BCG induction course was associated with better outcomes across all endpoints.
Invasion of the MM in primary T1 NMIBC is associated with a higher risk of upstaging to MIBC. Patients who received full BCG induction had similar outcomes regardless of substaging, whereas T1b patients without BCG induction experienced higher recurrence and progression rates.
本研究旨在通过一个大型单中心队列全面评估T1组织解剖亚分期（T1a/T1b）对高级别（HG）非肌层浸润性膀胱癌（NMIBC）的预后价值。
从我们的机构数据库中识别出2011年至2022年间原发性HG T1 NMIBC患者。收集从诊断到重复经尿道膀胱肿瘤切除术（RE-TURBT）、卡介苗（BCG）治疗及随访的数据。根据组织解剖标志将患者分为T1a（侵犯黏膜肌层以上-MM）和T1b（侵犯至MM内/超过MM）。采用Kaplan-Meier曲线和多变量Cox回归分析评估组织解剖亚分期对无复发生存期（RFS）、癌症特异性生存期（CSS）和无进展生存期（PFS）的影响。
88%的病例可行亚分期。中位（IQR）随访时间为40（17-72）个月。T1b患者初始肿瘤较大（>3 cm：43.2%对26.1%，p<0.001），而在RE-TURBT时T1b患者升级为肌层浸润性膀胱癌（MIBC）的频率高于T1a（5.9%对1.5%，p=0.02）。与T1a相比，未接受BCG诱导的T1b患者RFS和PFS更差（所有p≤0.02），而接受完整BCG诱导的患者未观察到差异。多变量分析显示，完成至少一个BCG诱导疗程与所有终点的更好结局相关。
原发性T1 NMIBC中MM受侵与升级为MIBC的较高风险相关。接受完整BCG诱导的患者无论亚分期如何，结局相似，而未接受BCG诱导的T1b患者复发和进展率更高。
