Metric substage according to micro and extensive lamina propria invasion improves prognostics in T1 bladder cancer

Journal article

Publication Details

Author(s): Van De Putte EEF, Otto W, Hartmann A, Bertz S, Mayr R, Bruendl J, Breyer J, Manach Q, Comperat EM, Boormans JL, Bosschieter J, Jewett MAS, Stoehr R, Van Leenders GJLH, Nieuwenhuijzen JA, Zlotta AR, Hendricksen K, Roupret M, Burger M, Van Der Kwast TH, Van Rhijn BWG
Journal: Urologic Oncology-Seminars and Original Investigations
Publication year: 2018
ISSN: 1078-1439


BACKGROUND: Reliable prognosticators for T1 bladder cancer (T1BC) are urgently needed.
OBJECTIVE: To compare the prognostic value of 2 substage systems for T1BC in patients treated by transurethral resection (TUR) and adjuvant bacillus Calmette-Guérin therapy.
DESIGN, SETTING, AND PARTICIPANTS: The slides of 601 primary T1BCs from four institutes were reviewed by 2 uropathologists and substaged according to 2 classifications: metric substage according to T1 microinvasive (T1m-lamina propria invasion <0.5mm) and T1 extensive invasive (pT1e-invasion ≥ 0.5mm), and according to invasion of the muscularis mucosae (MM) (T1a-invasion above or into MM/T1b).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable analyses for progression-free (PFS) and cancer-specific survival (CSS) were performed including substage, size, multiplicity, carcinoma in situ, sex, age, WHO-grade 1973, and WHO-grade 2004 as variables.
RESULTS: Median follow-up was 5.9 years (interquartile range: 3.3-9.0). Progression to T2BC was observed in 148 (25%) patients and 94 (16%) died of BC. The MM was not present at the invasion front in 135 (22%) of tumors. Slides were substaged as follows: 213 T1m and 388 T1e and 281 T1a and 320 T1b. On multivariable analysis, T1m/e substage and WHO 1973 grade were the strongest prognosticators for PFS (hazard ratio [HR] = 3.8 and HR = 1.8) and CSS (HR = 2.7 and HR = 2.6), respectively. Other prognostic factors for CSS were age (HR = 1.03), and tumor size (HR = 1.8). Substage according to MM-invasion was not significant. Our study was limited by its retrospective design and that standard re-TUR was not performed if TUR was macroscopically complete and muscularis propria was present in resected specimens.
CONCLUSIONS: Metric substaging of T1BC was possible in all cases of 601 T1BC patients and it was a strong independent prognosticator of both PFS and CSS.

FAU Authors / FAU Editors

Bertz, Simone PD Dr.
Pathologisches Institut
Hartmann, Arndt Prof. Dr. med.
Lehrstuhl für Allgemeine Pathologie und Pathologische Anatomie

External institutions with authors

Antoni van Leeuwenhoek
Erasmus University Medical Center
Universität Regensburg
University of Paris 4 - Paris-Sorbonne / Université paris IV Paris-Sorbonne
University of Paris 6 - Pierre et Marie Curie / Université Paris VI Pierre et Marie Curie (UPMC)
University of Toronto
Vrije Universiteit Amsterdam (VU) / University Amsterdam

How to cite

Van De Putte, E.E.F., Otto, W., Hartmann, A., Bertz, S., Mayr, R., Bruendl, J.,... Van Rhijn, B.W.G. (2018). Metric substage according to micro and extensive lamina propria invasion improves prognostics in T1 bladder cancer. Urologic Oncology-Seminars and Original Investigations.

Van De Putte, Elisabeth E. Fransen, et al. "Metric substage according to micro and extensive lamina propria invasion improves prognostics in T1 bladder cancer." Urologic Oncology-Seminars and Original Investigations (2018).


Last updated on 2018-22-10 at 14:38