Abstract
Background: The T1 substaging of bladder cancer (BCa) potentially impacts disease progression. The objective of the study was to compare the prognostic accuracy of two substaging systems on the recurrence and progression of primary pathologic T1 (pT1) BCa and to test a nomogram based on pT1 substaging for predicting recurrence-free survival (RFS) and progression-free survival (PFS).Methods: The medical records of 204 patients affected by pT1 BCa were retrospectively reviewed. Substaging was defined according to the depth of lamina propria invasion in T1a−c and the extension of the lamina propria invasion to T1-microinvasive (T1m) or T1-extensive (T1e). Uni- and multivariable Cox regression models evaluated the independent variables correlated with recurrence and progression. The predictive accuracies of the two substaging systems were compared by Harrell's C index. Multivariate Cox regression models for the RFS and PFS were also depicted by a nomogram.Results: The 5-year RFS was 47.5% with a significant difference between T1c and T1a (p = 0.02) and between T1e and T1m (p < 0.001). The 5-year PFS was 75.9% with a significant difference between T1c and T1a (p = 0.011) and between T1e and T1m (p < 0.001). Model T1m−e showed a higher predictive power than T1a−c for predicting RFS and PFS. In the univariate and multivariate model subcategory T1e, the diameter, location, and number of tumors were confirmed as factors influencing recurrence and progression after adjusting for the other variables. The nomogram incorporating the T1m−e model showed a satisfactory agreement between model predictions at 5 years and actual observations.Conclusions: Substaging is significantly associated with RFS and PFS for patients affected by T1 BCa and should be included in innovative prognostic nomograms.
Highlights
Up to 80% of bladder cancers (BCa) are non–muscle invasive during the first diagnosis [1]; ∼25% present as T1 lesions with invasion of the subepithelial connective tissue [1,2,3].The management of T1 BCa is controversial since it presents different degrees of aggressiveness, with a progression rate varying from 12 to 54% [4, 5]
The objective of the study was to compare the prognostic accuracy of two substaging systems on the recurrence and progression of primary pathologic T1 BCa and to test a nomogram based on pT1 substaging for predicting recurrence-free survival (RFS) and progression-free survival (PFS)
Substaging is significantly associated with RFS and PFS for patients affected by T1 BCa and should be included in innovative prognostic nomograms
Summary
Up to 80% of bladder cancers (BCa) are non–muscle invasive during the first diagnosis [1]; ∼25% present as T1 lesions with invasion of the subepithelial connective tissue (i.e., lamina propria) [1,2,3].The management of T1 BCa is controversial since it presents different degrees of aggressiveness, with a progression rate varying from 12 to 54% [4, 5]. Younes et al [7] were the first to use the muscularis mucosa (MM) in transurethrally resected biopsy specimens to substage (i.e., subcategorize) T1 BCa. Since several studies have been conducted to identify whether the depth of lamina propria invasion is a valuable prognostic factor with the use of the MM as a landmark for T1 substaging. Other studies underlined that the substaging of T1 BCa is technically difficult because MM and VP represent inconsistent histologic landmarks for staging (i.e., not always present). If present, these structures can be overrun by the invasive tumor, making substaging challenging. The objective of the study was to compare the prognostic accuracy of two substaging systems on the recurrence and progression of primary pathologic T1 (pT1) BCa and to test a nomogram based on pT1 substaging for predicting recurrence-free survival (RFS) and progression-free survival (PFS)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
