The impact of tumor invasion to muscularis mucosaevascular plexus on patient outcome in pT1 bladder urothelial carcinoma


Submitted: May 26, 2020
Accepted: June 22, 2020
Published: October 2, 2020
Abstract Views: 748
PDF: 321
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Ahmet Sahan Kartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Urology, Istanbul, Turkey.
  • Fatma Gerin Marmara University, Department of Pathology, Istanbul, Turkey.
  • Asgar Garayev Marmara University, Department of Urology, Istanbul, Turkey.
  • Emine Bozkurtlar Marmara University, Department of Pathology, Istanbul, Turkey.
  • Alkan Çubuk Kartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Urology, Istanbul, Turkey.
  • Orkunt Ozkaptan Kartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Urology, Istanbul, Turkey.
  • Kasım Ertas Yuzuncu Yıl University, Department of Urology, Van, Turkey.
  • Yıloren Tanıdır Marmara University, Department of Urology, Istanbul, Turkey.
  • Haydar Kamil Cam Marmara University, Department of Urology, Istanbul, Turkey.
  • Ilker Tınay Marmara University, Department of Urology, Istanbul, Turkey.

Objectives: T1 bladder cancer has a wide range of tumor behavior and lamina propria invasion depth has a high potential risk of disease progression. To evaluate the patient outcome according to the tumor invasion to the muscularis mucosae-vascular plexus (MM-VP) in pT1 bladder urothelial carcinoma (BUC).
Materials and methods: This study is a retrospective analysis of patients consecutively recorded from 2007 to 2013. A total of 93 patients with a history of primary pT1 BUC and complete follow-up were included. We used a pathological substaging system according to the tumor invasion regarding the MM-VP: pT1a (invasion above MM-VP) and pT1b (MM-VP invasion). We evaluated recurrence-free survival (RFS), progression- free survival (PFS), disease-specific-survival (DSS) based on this sub-staging system.
Results: Pathological evaluation regarding the MM-VP invasion revealed 53 patients (57%) as pT1a BUC and 40 patients (43%) as pT1b BUC. The mean follow-up was 78.8 months. During the follow-up period; 60 patients (64.5%) had tumor recurrences, 32 patients (34.4%) had progression to invasive disease, 18 patients (19.4 %) died during follow-up related to the BUC. In 29 (54.7%) of pT1a and in 31(77.5%) of pT1b tumors, the recurrent disease was recorded during the followup period (p = 0.023). DSS rates at 5 years for pT1a and pT1b were 80.2% and 60.8%, respectively. PFS, RFS, and DSS rates were similar for pT1a/pT1b and did not reach statistical significance (p > 0.05).
Conclusions: Sub-staging of pT1 BUC according to the MM-VP invasion showed a limited impact on the outcome in our patient cohort. However, the presence of pT1b disease caused a significantly higher rate of recurrence.


van Rhijn BW, Burger M, Lotan Y, et al. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol. 2009 Sep;56(3):430-42. PubMed PMID: 19576682. DOI: https://doi.org/10.1016/j.eururo.2009.06.028

Burger M, Oosterlinck W, Konety B, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: Non-muscle-invasive urothelial carcinoma of the bladder. Eur Urol. 2013 Jan;63(1):36-44. PubMed PMID: 22981672. DOI: https://doi.org/10.1016/j.eururo.2012.08.061

Hall MC, Chang SS, Dalbagni G, et al. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol. 2007 Dec;178(6):2314-30. PubMed PMID: 17993339. DOI: https://doi.org/10.1016/j.juro.2007.09.003

Kulkarni GS, Hakenberg OW, Gschwend JE, et al. An updated critical analysis of the treatment strategy for newly diagnosed high-grade T1 (previously T1G3) bladder cancer. Eur Urol. 2010 Jan;57(1):60-70. PubMed PMID: 19740595. DOI: https://doi.org/10.1016/j.eururo.2009.08.024

Cambier S, Sylvester RJ, Collette L, et al. EORTC Nomograms and Risk Groups for Predicting Recurrence, Progression, and Disease-specific and Overall Survival in Non-Muscle-invasive Stage Ta-T1 Urothelial Bladder Cancer Patients Treated with 1-3 Years of Maintenance Bacillus Calmette-Guerin. Eur Urol. 2016 Jan;69(1):60-9. PubMed PMID: 26210894. DOI: https://doi.org/10.1016/j.eururo.2016.01.055

Ozkaptan O, ;Çubuk, Alkan; Dinçer, Erdinç; Şahan, Ahmet; Kafkaslí, Alper; Akça, Oktay. Extraperitoneal Antegrade vs Transperitoneal Open Radical Cystectomy: Single Center Experiences with 200 Cases Bladder cancer. 2020. DOI: https://doi.org/10.3233/BLC-200280

Budak S, Yucel C, Keskin MZ, et al. Pathology outcomes in patients with transurethral bladder tumour resection in a Turkish population: A retrospective analysis. Arch Ital Urol Androl. 2018 Mar 31;90(1):8-10. PubMed PMID: 29633791. Epub 2018/04/11. DOI: https://doi.org/10.4081/aiua.2018.1.8

Mathieu R, Lucca I, Roupret M, Briganti A, Shariat SF. The prognostic role of lymphovascular invasion in urothelial carcinoma of the bladder. Nat Rev Urol. 2016 Aug;13(8):471-9. PubMed PMID: 27431340. DOI: https://doi.org/10.1038/nrurol.2016.126

Breyer J.1 BS, Müller A.2, Lausenmeyer E-M.1, Mayr R.1, Gierth M.1, Burger M.1, Denzinger S.1, Hartmann A.2, Otto W.1. New pathological features predicting prognosis of early-invasive urothelial carcinoma: Quantitative substaging and tumour invasion pattern should assist WHO 1973 grading classification in predicting cancer-specific survival of stage pT1 bladder cance. Eur Urol Suppl 2016;15(3):e392. DOI: https://doi.org/10.1016/S1569-9056(16)60394-9

Naselli A, Hurle R, Paparella S, et al. Role of Restaging Transurethral Resection for T1 Non-muscle invasive Bladder Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus. 2017 Jan 13. PubMed PMID: 28753839. DOI: https://doi.org/10.1016/j.euf.2016.12.011

Younes M, Sussman J, True LD. The usefulness of the level of the muscularis mucosae in the staging of invasive transitional cell carcinoma of the urinary bladder. Cancer. 1990 Aug 1;66(3):543-8. PubMed PMID: 2364365. DOI: https://doi.org/10.1002/1097-0142(19900801)66:3<543::AID-CNCR2820660323>3.0.CO;2-R

van Rhijn BW, van der Kwast TH, Alkhateeb SS, et al. A new and highly prognostic system to discern T1 bladder cancer substage. Eur Urol. 2012 Feb;61(2):378-84. PubMed PMID: 22036775. DOI: https://doi.org/10.1016/j.eururo.2011.10.026

Orsola A, Trias I, Raventos CX, et al. Initial high-grade T1 urothelial cell carcinoma: feasibility and prognostic significance of lamina propria invasion microstaging (T1a/b/c) in BCG-treated and BCG-non-treated patients. Eur Urol. 2005 Aug;48(2):231-8; discussion 8. PubMed PMID: 15963635. DOI: https://doi.org/10.1016/j.eururo.2005.04.013

Turan T, Efiloglu O, Gunaydin B, et al. Comparative differences between T1a/b and T1e/m as substages in T1 urothelial carcinoma of the bladder. Int Braz J Urol. 2018 Mar-Apr;44(2):267-72. PubMed PMID: 29219283. Pubmed Central PMCID: PMC6050560. DOI: https://doi.org/10.1590/s1677-5538.ibju.2017.0424

Babjuk M, Bohle A, Burger M, et al. EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2016. Eur Urol. 2017 Mar;71(3):447-61. PubMed PMID: 27324428. DOI: https://doi.org/10.1016/j.eururo.2016.05.041

Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part B: Prostate and Bladder Tumours. Eur Urol. 2016 Jul;70(1):106-19. PubMed PMID: 26996659. DOI: https://doi.org/10.1016/j.eururo.2016.02.028

Smits G, Schaafsma E, Kiemeney L, Caris C, Debruyne F, Witjes JA. Microstaging of pT1 transitional cell carcinoma of the bladder: identification of subgroups with distinct risks of progression. Urology. 1998 Dec;52(6):1009-13; discussion 13-4. PubMed PMID: 9836546. DOI: https://doi.org/10.1016/S0090-4295(98)00374-4

Lee JY, Joo HJ, Cho DS, Kim SI, Ahn HS, Kim SJ. Prognostic Significance of Substaging according to the Depth of Lamina Propria Invasion in Primary T1 Transitional Cell Carcinoma of the Bladder. Korean J Urol. 2012 May;53(5):317-23. PubMed PMID: 22670190. Pubmed Central PMCID: PMC3364470. DOI: https://doi.org/10.4111/kju.2012.53.5.317

Platz CE, Cohen MB, Jones MP, Olson DB, Lynch CF. Is microstaging of early invasive cancer of the urinary bladder possible or useful? Mod Pathol. 1996 Nov;9(11):1035-9. PubMed PMID: 8933512.

V DEM, Cerruto MA, D'Elia C, et al. Prognostic role of substaging in T1G3 transitional cell carcinoma of the urinary bladder. Mol Clin Oncol. 2014 Jul;2(4):575-80. PubMed PMID: 24940498. Pubmed Central PMCID: PMC4051551. DOI: https://doi.org/10.3892/mco.2014.290

Holmang S, Hedelin H, Anderstrom C, Holmberg E, Johansson SL. The importance of the depth of invasion in stage T1 bladder carcinoma: a prospective cohort study. J Urol. 1997 Mar;157(3):800-3; discussion 4. PubMed PMID: 9072570. DOI: https://doi.org/10.1016/S0022-5347(01)65044-4

Amin MB, McKenney JK, Paner GP, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: Pathology. Eur Urol. 2013 Jan;63(1):16-35. PubMed PMID: 23083804. DOI: https://doi.org/10.1016/j.eururo.2012.09.063

Ro JY, Ayala AG, el-Naggar A. Muscularis mucosa of urinary bladder. Importance for staging and treatment. Am J Surg Pathol. 1987 Sep;11(9):668-73. PubMed PMID: 3631381. DOI: https://doi.org/10.1097/00000478-198709000-00002

Roupret M, Seisen T, Comperat E, et al. Prognostic interest in discriminating muscularis mucosa invasion (T1a vs T1b) in nonmuscle invasive bladder carcinoma: French national multicenter study with central pathology review. J Urol. 2013 Jun;189(6):2069-76. PubMed PMID: 23201497. DOI: https://doi.org/10.1016/j.juro.2012.11.120

Soukup V, Duskova J, Pesl M, et al. The prognostic value of T1 bladder cancer substaging: a single institution retrospective study. Urol Int. 2014;92(2):150-6. PubMed PMID: 24481124. DOI: https://doi.org/10.1159/000355358

Patriarca C, Hurle R, Moschini M, et al. Usefulness of pT1 substaging in papillary urothelial bladder carcinoma. Diagn Pathol. 2016 Jan 20;11:6. PubMed PMID: 26791567. Pubmed Central PMCID: PMC4721190. DOI: https://doi.org/10.1186/s13000-016-0466-6

Gershman B, Boorjian SA, Hautmann RE. Management of T1 Urothelial Carcinoma of the Bladder: What Do We Know and What Do We Need To Know? Bladder Cancer. 2015 Sep 5;2(1):1-14. PubMed PMID: 27376120. Pubmed Central PMCID: PMC4927848. Epub 2015/01/01. DOI: https://doi.org/10.3233/BLC-150022

Sahan, A., Gerin, F., Garayev, A., Bozkurtlar, E., Çubuk, A., Ozkaptan, O., Ertas, K., Tanıdır, Y., Cam, H. K., & Tınay, I. (2020). The impact of tumor invasion to muscularis mucosaevascular plexus on patient outcome in pT1 bladder urothelial carcinoma. Archivio Italiano Di Urologia E Andrologia, 92(3). https://doi.org/10.4081/aiua.2020.3.239

Downloads

Download data is not yet available.

Citations