Utility of pT3 substaging in lymph node-negative urothelial carcinoma of the bladder: do pathologic parameters add to prognostic sub-stratification?

Georgios Gakis,Moritz Maas,Marcus Scharpf,Falko Fend,Tilman Todenhöfer,Eva Compérat,Arnulf Stenzl,Steffen Rausch,Johannes Mischinger

doi:10.1007/s00345-021-03697-3

Georgios Gakis, Moritz Maas + Show 7 more

Open Access

https://doi.org/10.1007/s00345-021-03697-3

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Abstract

PurposeThe value of bladder cancer (BC) substaging into macroscopic (pT3b) and microscopic (pT3a) perivesical fat extension in lymph node (Ln)-negative patients is controversially discussed and limited evidence for prognostic relevance of additional histopathological factors in pT3 BC exists. We evaluated the prognostic value of pT3 substaging and established pathological and clinical parameters with focus on tumor invasive front (TIF) and tumor size.MethodsSpecimens of 52 patients treated with radical cystectomy (RC) for pT3 a/b muscle-invasive BC were reviewed and re-evaluated by a pathologist specialized in uropathology. Clinical variables and standard histopathologic characteristics were assessed including TIF and tumor size. Their value as prognosticators for overall survival (OS) and recurrence-free survival (RFS) was evaluated.ResultsMean age of patients was 67.55 years. Tumors were staged pT3a in 28 patients (53.8%) and pT3b in 24 (46.8%). Median OS was 34.51 months. Median tumor size was 3.2 cm, median TIF was 11.0 mm. Differences in OS between pT3a and pT3b were not significant (p = 0.45). Carcinoma in situ (CIS) and lymphovascular invasion (LVI) were significantly associated with pT3b tumors. Univariate analysis could not identify pathological prognosticators like TIF or tumor size for OS and RFS (p for all > 0.05).ConclusionNo significant differences in OS or RFS were observed comparing Ln-negative pT3 BC following radical cystectomy. Additional pathologic variables like TIF could not be identified as prognosticator. Relevance of pT3 BC substaging needs reevaluation in larger prospective cohorts.

Highlights

Bladder cancer (BC) is one of the ten most common malignancies worldwide and the second most common uro-oncological entity [1]
We identified 52 node-negative patients with pT3a/b urothelial cancer that underwent radical cystectomy and lymphadenectomy
Median tumor size was 3.2 cm and median tumor invasive front (TIF) was 11.0 mm

Summary

Introduction

Bladder cancer (BC) is one of the ten most common malignancies worldwide and the second most common uro-oncological entity [1]. According to the currently applied classification, tumors extending the bladder without invading surrounding organs are separated into pT3a and pT3b In this context, pT3a tumors show a microscopic and pT3b a macroscopic invasion of the perivesical fat. The prognostic significance of this distinction remains subject of controversial debates: In comparison to pT2 tumors, pT3 disease including both, pT3a and pT3b is associated with impaired prognosis [3]. This prognostic relevance has not consistently been reported for the comparison of pT3a and pT3b tumors, which led to discussion about the clinical importance of the pT3 sub-classification [4]

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