Necessity and Usefulness of Pathological T1 Subclassfication in the Management of Bladder Urothelial Carcinoma.
Hiroyuki Takahashi, Toshihiro Yamamoto, Sainosuke Mizukami, Masakuni Furusato, Shin Egawa, Makoto Fujime, Hiroshi Hano. The Jikei University School of Medicine, Tokyo, Japan; School of Medicine, Juntendo University, Tokyo, Japan
Background: Superficial urothelial carcinoma of urinary bladder is treated by trans-urethral resection (TUR) in contemporary urological practice. In the current TNM classification, T1 tumor is defined as invading subepithelial tissue, although it seems to contain various degrees of tumors from early microinvasion through massive invasive cancer.
Design: Primary urothelial carcinoma of urinary bladder obtained by TUR from 2000 through 2008 (n=772) was evaluated and pT1 tumor was chosen. Clinicopathological data were analyzed. Subclassification of pT1 was defined as follows; pT1a: microinvasion with width<5mm, depth<1mm, less than 5 invasive foci; pT1c: massive invasive tumor with >50% of invasive area; pT1b: between a and c. Cases of pT1b and c containing no muscularis propria in the specimens were omitted from this study. Recurrence-free, progression-free, and cause-specific survivals (RFS, PFS, and CSS) were assessed.
Results: 122 cases of pT1 tumors were identified and follow-up data (range: 36-120 months; median 48 m) were available in 105 cases. Median patients' age was 68y. Second-look TUR was not performed in most of the cases. They were subclassified as 46 of pT1a, 34 of pT1b and 25 of pT1c. In pT1a tumors, invasive areas were from 0.1x0.1mm to 4x1mm and foci ranged from 1 to 4. In pT1c tumors, % of invasive tumors ranged from 70 to 100%. RFS was not statistically significant among 3 groups. PFS of pT1c was significantly lower than pT1a and b. CSS of pT1c was significantly lower than pT1a. In pT1a tumor, 5-year RFS rate was 44% but PFS and CSS rates were 92 and 98%, respectively.
Conclusions: Subclassification of pT1 is necessary and useful in the management of bladder urothelial carcinoma. Second-look TUR without recurrent findings may not be necessary to pT1a tumor, whereas it should be done to pT1c tumor.
Category: Genitourinary (including renal tumors)
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 196, Tuesday Morning