کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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3924163 | 1253093 | 2012 | 7 صفحه PDF | دانلود رایگان |
BackgroundManagement of T1 bladder cancer (BCa) is controversial.ObjectiveEvaluate the impact of substage on the clinical outcome of T1 BCa.Design, setting, and participantsThe T1 diagnosis of 134 first-diagnosis BCa patients from two university hospitals was confirmed. For the T1 substage, we used a new system that discerns T1-microinvasive (T1m) and T1-extensive-invasive (T1e) tumors. We then determined the invasion of the muscularis mucosae–vascular plexus (MM-VP): T1a (invasion above the MM-VP), T1b (invasion in the MM-VP), or T1c (invasion beyond the MM-VP). If the MM-VP was not present at the invasion front, the case was assigned to T1a or T1c. All patients were initially managed conservatively (with bacillus Calmette-Guérin).MeasurementsMultivariable analyses for progression and disease-specific survival (DSS).Results and limitationsMedian follow-up was 6.4 yr (interquartile range: 3.3–9.2 yr). Progression to ≥T2 was observed in 40 patients (30%), and 19 patients (14%) died of BCa. The MM-VP was not present at the invasion front in 50 patients (37%). T1 substage was as follows: 40 T1m and 94 T1e; 81 T1a, 18 T1b, and 35 T1c. In multivariable analyses, substage (T1m/T1e) was significant for progression (p = 0.001) and DSS (p = 0.032), whereas substage according to T1a/T1b/T1c was not significant. Female gender (p = 0.006) and carcinoma in situ (p = 0.034) were also significant predictors of progression. The main limitation to the study is absence of a repeat transurethral resection.ConclusionsSubstage according to the new system (T1m and T1e) was user-friendly, possible in 100% of cases, and very predictive of T1 BCa behavior. Future studies may ultimately lead to the incorporation of this new substaging system in the TNM classification system for urinary BCa.
Journal: European Urology - Volume 61, Issue 2, February 2012, Pages 378–384