Vertical Lamina Propria Invasion Diagnosed by En Bloc Transurethral Resection is a Significant Predictor of Progression for pT1 Bladder Cancer

No AccessJournal of UrologyAdult Urology1 Jun 2021Vertical Lamina Propria Invasion Diagnosed by En Bloc Transurethral Resection is a Significant Predictor of Progression for pT1 Bladder Cancer Takafumi Yanagisawa, Jun Miki, Takashi Yorozu, Kosuke Iwatani, Koki Obayashi, Shun Sato, Takahiro Kimura, Hiroyuki Takahashi, and Shin Egawa Takafumi YanagisawaTakafumi Yanagisawa *Correspondence: Department of Urology, Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567Japan telephone: +81-4-7164-1111; FAX: +81-4-7166-9374; E-mail Address: [email protected] http://orcid.org/0000-0002-7410-0712 Department of Urology, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Jun MikiJun Miki Department of Urology, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Takashi YorozuTakashi Yorozu Department of Pathology, The Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan More articles by this author , Kosuke IwataniKosuke Iwatani Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan Funded by the National Institutes of Health. More articles by this author , Koki ObayashiKoki Obayashi Department of Urology, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Shun SatoShun Sato Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Takahiro KimuraTakahiro Kimura Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , Hiroyuki TakahashiHiroyuki Takahashi Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author , and Shin EgawaShin Egawa Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan Financial interest and/or other relationship with Takeda, Astellas, AstraZeneca, Sanofi, Janssen and Pfizer. More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001630AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: T1 bladder cancer is characterized by high recurrence and aggressive progression. Muscularis mucosae invasion may be a prognostic factor for progression, but the limitations of conventional transurethral resection of bladder tumors make diagnosis difficult. We correlated degree of invasion with oncologic outcome and evaluated the utility of pathological diagnosis following en bloc resection of bladder tumors. Materials and Methods: We retrospectively analyzed the records of 123 consecutive patients diagnosed with pT1 bladder cancer between November 2013 and December 2018. Transurethral resection was conducted in 91 patients, and en bloc resection in 32 patients. All specimens were analyzed for invasion depth and pT1 substaging (T1a/b: invasion above or into/beyond muscularis mucosae, pT1m/e: microinvasive or extensively invasive). Primary end points were prognostic values of pT1 substaging and invasion depth. The secondary end point was the pathological diagnostic utility of en bloc resection. Results: Median followup was 23 months. Three-year progression-free survival rate differed significantly depending on muscularis mucosae invasion (pT1a: 97.3%, pT1b: 72.8%; p=0.003) and invasion depth from basal membrane (<2 mm: 90.6%, ≥2 mm: 77.9%; p=0.03). Multivariate analysis showed that sessile tumor and invasion depth from basal membrane ≥2 mm were independent prognostic factors for progression. Diagnostic rates for pT1a/b and invasion depth were 77.6% and 85.9%, respectively, with transurethral resection, but 100% and 100% with en bloc resection (p=0.01 and p=0.03). Conclusions: Vertical lamina propria invasion is predictive of progression in T1 bladder cancer, underlining the importance of accurately diagnosing the degree of vertical lamina propria invasion with en bloc resection. References 1. : European Association of Urology guidelines on non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ)—2019 update. Eur Urol 2019; 76: 639. Google Scholar 2. : Management of stage T1 tumors of the bladder: international consensus panel. Urology, suppl., 2005; 66: 108. Google Scholar 3. : Repeat transurethral resection in non-muscle-invasive bladder cancer: a systematic review. Eur Urol 2018; 73: 925. Google Scholar 4. : The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomized clinical trial. J Urol 2006; 175: 1641. Link, Google Scholar 5. : Effect of routine repeat transurethral resection for superficial bladder cancer: a long-term observational study. J Urol 2003; 170: 433. Link, Google Scholar 6. : The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high-grade/grade 3 bladder cancer treated with bacille Calmette-Guerin. BJU Int 2016; 118: 44. Google Scholar 7. : Improving selection criteria for early cystectomy in high-grade T1 bladder cancer: a meta-analysis of 15,215 patients. J Clin Oncol 2015; 33: 643. Google Scholar 8. : Prognostic significance of substage and WHO classification systems in T1 urothelial carcinoma of the bladder. Curr Opin Urol 2015; 25: 427. Google Scholar 9. : The usefulness of the level of the muscularis mucosae in the staging of invasive transitional cell carcinoma of the urinary bladder. Cancer 1990; 66: 543. Google Scholar 10. : Prognostic significance in substaging ofT1 urinary bladder urothelial carcinoma on transurethral resection. Am J Surg Pathol 2012; 36: 454. Google Scholar 11. : Reexamining treatment of high-grade T1 bladder cancer according to depth of lamina propria invasion: a prospective trial of 200 patients. Br J Cancer 2015; 112: 468. Google Scholar 12. : 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; 189: 2069. Link, Google Scholar 13. : A new system for substaging pT1 papillary bladder cancer: a prognostic evaluation. Hum Pathol 2005; 36: 981. Google Scholar 14. : A new and highly prognostic system to discern T1 bladder cancer substage. Eur Urol 2012; 61: 378. Google Scholar 15. : Prognostic factors in T1 bladder urothelial carcinoma: the value of recording millimetric depth of invasion, diameter of invasive carcinoma, and muscularis mucosa invasion. Hum Pathol 2013; 44: 95. Google Scholar 16. : Substaging of T1 bladder carcinoma based on the depth of invasion as measured by micrometer: a new proposal. Cancer 1999; 86: 1035. Google Scholar 17. : A new technique for transurethral resection of superficial bladder tumor in 1 piece. J Urol 2000; 163: 878. Link, Google Scholar 18. : Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transpl 2013; 48: 452. Google Scholar 19. : Current concept of transurethral resection of bladder cancer: from re-transurethral resection of bladder cancer to en-bloc resection. Curr Opin Urol 2018; 28: 591. Google Scholar 20. : Transurethral en bloc resection of nonmuscle invasive bladder cancer: trend or hype. Curr Opin Urol 2017; 27: 182. Google Scholar 21. : Current evidence of transurethral en-bloc resection of nonmuscle invasive bladder cancer: update 2016. Eur Urol Focus 2017; 3: 567. Google Scholar 22. : Thulium laser endoscopic en bloc enucleation of nonmuscle-invasive bladder cancer. J Endourol 2015; 29: 1258. Google Scholar 23. : Transurethral resection in one piece (TURBO) is an accurate tool for pathological staging of bladder tumor. Int J Urol 2010; 17: 708. Google Scholar 24. : Tm:YAG laser en bloc mucosectomy for accurate staging of primary bladder cancer: early experience. World J Urol 2011; 29: 429. Google Scholar Authors’ contributions: TYa contributed to the protocol and project development, data collection and management, data analysis, and manuscript writing and editing. JM contributed to the protocol and project development, and to manuscript editing. TYo and SS contributed to pathological diagnosis. KI and KO contributed to data collection. TK, HT and SE contributed to manuscript editing. Editor's Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1852 and 1853. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 205Issue 6June 2021Page: 1622-1628 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsurinary bladder neoplasmsurologic surgical proceduresneoplasm stagingAcknowledgmentEnglish-language editorial support was provided by Seaman Medical, Inc.MetricsAuthor Information Takafumi Yanagisawa Department of Urology, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan *Correspondence: Department of Urology, Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567Japan telephone: +81-4-7164-1111; FAX: +81-4-7166-9374; E-mail Address: [email protected] More articles by this author Jun Miki Department of Urology, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Takashi Yorozu Department of Pathology, The Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan More articles by this author Kosuke Iwatani Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan Funded by the National Institutes of Health. More articles by this author Koki Obayashi Department of Urology, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Shun Sato Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Takahiro Kimura Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Hiroyuki Takahashi Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan More articles by this author Shin Egawa Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan Financial interest and/or other relationship with Takeda, Astellas, AstraZeneca, Sanofi, Janssen and Pfizer. More articles by this author Expand All Authors’ contributions: TYa contributed to the protocol and project development, data collection and management, data analysis, and manuscript writing and editing. JM contributed to the protocol and project development, and to manuscript editing. TYo and SS contributed to pathological diagnosis. KI and KO contributed to data collection. TK, HT and SE contributed to manuscript editing. Editor's Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1852 and 1853. Advertisement PDF DownloadLoading ...