Abstract
BackgroundWe evaluated the clinical significance and prognostic value of histopathological features of bladder cancer, such as subepithelial growth patterns and tumor growth pattern at the invasion front.MethodsIn total, 130 patients newly diagnosed with non-muscle invasive bladder cancer and underwent transurethral resection between 1998 and 2009 were enrolled. Subepithelial growth patterns consisting of endophytic growth pattern (EGP) and von Brunn's nest involvement (VBNI) were investigated using hematoxylin and eosin-stained slides, and their frequency of occurrence, prognostic value, and correlation with other clinicopathological features was evaluated.ResultsEGP and VBNI were found in 40 (30.8%) and 5 (3.9%) of the 130 cases, respectively. Of the 26 pT1 tumors, the growth pattern at the invasion front was trabecular in 17 (65.4%) and infiltrative in 9 (34.6%). Although 8 (47.1%) of 17 trabecular tumors coexisted with EGP, no cases with infiltrative tumors had EGP (p = 0.023). VBNI correlated with high tumor grades (p = 0.006) and lymphovascular involvement (p = 0.026). The multivariate Cox proportional hazards analysis revealed that tumor diameter less than 3 cm (p = 0.04) and intravesical bacillus Calmette-Guérin therapy (p = 0.004) were independent favorable prognostic factors for recurrence-free survival, whereas tumor stage was an independent poor prognostic factor for disease progression (p = 0.006).ConclusionsSubepithelial growth patterns were not a significant prognostic factor in this study. Additionally, no tumors with an infiltrative growth pattern coexisted with EGP, suggesting that determining the presence of EGP might be helpful for managing non-muscle invasive bladder cancers.
Highlights
We evaluated the clinical significance and prognostic value of histopathological features of bladder cancer, such as subepithelial growth patterns and tumor growth pattern at the invasion front
We retrospectively reviewed the records of 130 patients with newly diagnosed non-muscle invasive bladder cancers (NMIBCs) in order to elucidate the clinical relevance of subepithelial growth patterns
All hematoxylin and eosin-stained slides were reviewed by a single uropathologist (K.S.) for staging [11]; grading [12]; presence of endophytic growth pattern (EGP), von Brunn’s nest involvement (VBNI), carcinoma in situ (CIS) and lymphovascular involvement (LVI); and determination of the growth pattern in the 26 cT1 tumors
Summary
We evaluated the clinical significance and prognostic value of histopathological features of bladder cancer, such as subepithelial growth patterns and tumor growth pattern at the invasion front. Von Brunn’s nests are clusters of urothelial cells within the lamina propria that have become detached from the overlying epithelium [4]. These nests have been commonly identified in 80-90% of normal bladders in autopsy studies [4,5]. A retrospective study demonstrated that VBNI lesions occurred in 73/371 (19.1%) patients with NMIBC, and its presence was not a risk factor for disease progression nor an absolute indication for radical cystectomy [5]. Since the first report describing VBNI by Seemayer et al [6], there have been very few reports on its clinical significance [2,5]
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