Significance of muscularis mucosae on the risk of recurrence and progression in patients with superficial bladder cancer

Abstract

Background. Due to the currently accepted operative technique of the transurethral resection (TUR) of bladder, during the surgery we obtain a histological material that is multiple pieces of the tissueof exophytic area of tumor, the bladder base and the bladder wall, in which a specialist histologist can be guided only with careful labeling, and the correct pathologic diagnosis is possible only in case of the presence of all layers of the bladder wall in the preparation. The performanceof TUR of bladderen blochas allowed visualizing an additional morphological feature in the preparation – its own muscularis mucosa. Objective. The evaluation of effectiveness of the transurethral surgical treatment of thepatients with superficial bladder cancer by comparing the immediate and long-term results of the standard TUR and the TUR of bladder wall tumor en bloc. The assessment of the role of the tumor invasion of propermuscularis mucosa in the prediction of recurrence and progression of superficial bladder cancer. Materials and methods. We analyzed the results of the examination and treatment of 270 patients with newly diagnosed «bladder cancer» who were treated between 2003 and 2012. All patients were divided into 2 groups: the main group (n = 94) who underwent the transurethral resection of the wall bladder tumor en bloc, and the compared group (n = 176) who underwent the standard transurethral resection. As a result wehave evaluated the role of the tumor invasion of propermuscularis mucosa in the prediction of recurrence and progression of superficial bladder cancer. Results and conclusions. The technique of the operation affects the recurrence rate by reducing it from 47.7 % in cases of the standard TUR to 34 % in cases of the TUR en bloc (p 0.05). The application of the TUR en bloc reduces the frequency of progressionby 4 times (p < 0.001) and increases the termsbeforethe progression by almost 2 times (p < 0.05). It allows to reduce the recurrences in the area of the resection to a minimum and to increase the periods before the occurrence of relapse. The presence of the damage ofproper muscularis mucosa (the in-growth or invasion, the categories T1b and T1c) increases the frequency of relapses for more than 2 times, and the way out of the tumor outside the layer of proper muscularis mucosareduces the term of relapse by 2.5 times, the progression rate increases from 2 % to 22.7 % and 18.5 %, and the average time before progression reduces from 41.5 to 26.0 and 17.1 with increase of the depth of tumor invasion with categories T1a, T1b and T1c respectively.