Korean J Urol.  2012 May;53(5):317-323.

Prognostic Significance of Substaging according to the Depth of Lamina Propria Invasion in Primary T1 Transitional Cell Carcinoma of the Bladder

• Lee JY
• Joo HJ
• Cho DS
• Kim SI
• Ahn HS
• Kim SJ

Abstract

PURPOSE
To evaluate the prognostic significance of the depth of lamina propria invasion in primary T1 transitional cell carcinoma (TCC) of the bladder.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 183 patients with primary T1 TCC of the bladder who had undergone transurethral resection (TUR) at our institution. Substaging was defined according to the depth of lamina propria invasion as follows: T1a, superficial invasion of lamina propria; T1b, invasion into the muscularis mucosa (MM); T1c, invasion beyond the MM but not to the muscularis propria. The prognostic significance of various clinicopathological variables for recurrence and progression was analyzed.
RESULTS
Of the 183 patients, substaging was T1a in 119, T1b in 57, and T1c in 7 patients. The recurrence rate was 32.8% for T1a and 40.6% for T1b/c, but there was no significant difference between the two groups. The progression rate was significantly different between the two groups: 5.8% in T1a and 21.9% in T1b/c (p=0.003). The cancer-specific mortality rate was also significantly different: 4.2% in T1a and 14.0% in T1b/c (p=0.036). In the univariate analysis, microscopic tumor architecture was the only significant prognostic factor for recurrence. In the univariate and multivariate analysis concerning progression, depth of lamina propria invasion and concomitant carcinoma in situ were significant prognostic factors.
CONCLUSIONS
Substaging according to the depth of lamina propria invasion in primary T1 TCC of the bladder was an independent prognostic factor for progression. This suggests that substaging would be helpful for guiding decisions about adjuvant therapies and follow-up strategies.

Keyword

Lamina propria; Muscularis mucosae; Prognosis; Urinary bladder neoplasms

MeSH Terms

Carcinoma in Situ
Carcinoma, Transitional Cell
Humans
Medical Records
Mucous Membrane
Multivariate Analysis
Prognosis
Recurrence
Retrospective Studies
Urinary Bladder
Urinary Bladder Neoplasms

Figure

• 

  FIG. 1 Hematoxylin-eosin-stained paraffin sections of three distinct bladder cancers. (A) Ta; no invasion into the muscularis mucosa (MM) showing MM and muscularis propria (MP). (B) T1a; superficial invasion of the lamina propria. (C) T1b; invasion into the MM. (The tumor base limit is marked with an arrow).

• 

  FIG. 2 Kaplan-Meier estimates of recurrence-free (A) and progression-free (B) survival according to the depth of lamina propria invasion in primary T1 transitional cell carcinoma (TCC) of the bladder. Whereas the recurrence-free interval was similar for both groups, the progression-free interval was significantly shorter in patients with T1b/c compared with T1a tumors.

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