Renzo Colombo1, Rodolfo Hurle2, Marco Moschini3, Massimo Freschi4, Piergiuseppe Colombo5, Maurizio Colecchia6, Lucia Ferrari7, Roberta Lucianò4, Giario Conti8, Tiziana Magnani9, Paolo Capogrosso1, Andrea Conti8, Luisa Pasini2, Giusy Burgio1, Giorgio Guazzoni10, Carlo Patriarca7. 1. Division of Oncology/Urology, Urological Research Institute, IRCCS, Ospedale S. Raffaele, Milan, Italy. 2. Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Milan, Italy. 3. Division of Oncology/Urology, Urological Research Institute, IRCCS, Ospedale S. Raffaele, Milan, Italy. Electronic address: marco.moschini87@gmail.com. 4. Department of Pathology, Ospedale San Raffaele, Milan, Italy. 5. Department of Pathology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy. 6. Uropathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 7. Department of Pathology, Azienda Ospedaliera Sant'Anna, Como, Italy. 8. Department of Urology, Azienda Ospedaliera Sant'Anna, Como, Italy. 9. Prostate Cancer Programme, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 10. Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Humanitas University, Milan, Italy.
Abstract
BACKGROUND: Decision making in T1 high-grade bladder cancer patients remains a challenging issue in urologic practice. OBJECTIVE: To assess the feasibility and potential prognostic role of three different substaging systems in specimens from both primary and second transurethral resection (TUR) of the bladder in T1 high-grade bladder cancer patients. DESIGN, SETTING, AND PARTICIPANTS: A total of 250 consecutive, confirmed pure transitional T1 high-grade bladder tumors submitted to second TUR entered the retrospective study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Feasibility of two already clinically tested microstaging systems (anatomy-based T1a/T1b/T1c and micrometric T1m/T1e with 0.5-mm thresholds of invasion) and that of a micrometric substage designed by the authors and based on a 1-mm threshold of invasion (Rete Oncologica Lombarda [ROL] system) was assessed by five independent uropathologists on both first and second TUR specimens. Univariable Cox proportional hazards models were attempted to identify significant independent predictors of recurrence and progression after TUR. Kaplan-Meier curves were plotted to compare different substaging methods analyzing recurrence and progression. RESULTS AND LIMITATIONS: The ROL system proved to be feasible in nearly all cases at both first and second TUR. Median follow-up was 60 mo. The univariate Cox regression analysis documented the ROL substage (ROL2 vs ROL1) to be the only statistically significant predictor of progression (hazard ratio: 2.01; 95% CI, 1.03-3.79; p<0.03). For the first time to our knowledge, the substage was investigated and used to assess T1 tumors found at second TUR, registering a high rate of feasibility. CONCLUSIONS: T1 microstaging using different procedures is feasible on both primary- and second-TUR specimens. A high rate of feasibility may be expected for T1m/T1e and ROL systems. The clinical role of microstaging on second TUR remains to be defined. PATIENT SUMMARY: The Rete Oncologica Lombarda system showed feasible results in T1 high-grade bladder tumors. Our substratification was predictive of progression of disease.
BACKGROUND: Decision making in T1 high-grade bladder cancerpatients remains a challenging issue in urologic practice. OBJECTIVE: To assess the feasibility and potential prognostic role of three different substaging systems in specimens from both primary and second transurethral resection (TUR) of the bladder in T1 high-grade bladder cancerpatients. DESIGN, SETTING, AND PARTICIPANTS: A total of 250 consecutive, confirmed pure transitional T1 high-grade bladder tumors submitted to second TUR entered the retrospective study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Feasibility of two already clinically tested microstaging systems (anatomy-based T1a/T1b/T1c and micrometric T1m/T1e with 0.5-mm thresholds of invasion) and that of a micrometric substage designed by the authors and based on a 1-mm threshold of invasion (Rete Oncologica Lombarda [ROL] system) was assessed by five independent uropathologists on both first and second TUR specimens. Univariable Cox proportional hazards models were attempted to identify significant independent predictors of recurrence and progression after TUR. Kaplan-Meier curves were plotted to compare different substaging methods analyzing recurrence and progression. RESULTS AND LIMITATIONS: The ROL system proved to be feasible in nearly all cases at both first and second TUR. Median follow-up was 60 mo. The univariate Cox regression analysis documented the ROL substage (ROL2 vs ROL1) to be the only statistically significant predictor of progression (hazard ratio: 2.01; 95% CI, 1.03-3.79; p<0.03). For the first time to our knowledge, the substage was investigated and used to assess T1 tumors found at second TUR, registering a high rate of feasibility. CONCLUSIONS: T1 microstaging using different procedures is feasible on both primary- and second-TUR specimens. A high rate of feasibility may be expected for T1m/T1e and ROL systems. The clinical role of microstaging on second TUR remains to be defined. PATIENT SUMMARY: The Rete Oncologica Lombarda system showed feasible results in T1 high-grade bladder tumors. Our substratification was predictive of progression of disease.
Authors: Chiara Lonati; Luca Afferi; Andrea Mari; Andrea Minervini; Wojciech Krajewski; Marco Borghesi; Gerald B Schulz; Michael Rink; Francesco Montorsi; Alberto Briganti; Renzo Colombo; Alberto Martini; Andrea Necchi; Roberto Contieri; Rodolfo Hurle; Paolo Umari; Stefania Zamboni; Claudio Simeone; Francesco Soria; Giancarlo Marra; Paolo Gontero; Jeremy Yuen-Chun Teoh; Tobias Klatte; Anne-Sophie Bajeot; Mathieu Roumiguié; Morgan Rouprêt; Alexandra Masson-Lecomte; Ekaterina Laukhtina; Anne Sophie Valiquette; M Carmen Mir; Alessandro Antonelli; Sarah M H Einerhand; Kees Hendricksen; Roberto Carando; Christian D Fankhauser; Philipp Baumeister; Agostino Mattei; Shahrokh F Shariat; Marco Moschini Journal: World J Urol Date: 2022-02-26 Impact factor: 4.226
Authors: Mehdi Kardoust Parizi; Dmitry Enikeev; Petr V Glybochko; Veronika Seebacher; Florian Janisch; Harun Fajkovic; Piotr L Chłosta; Shahrokh F Shariat Journal: World J Urol Date: 2019-09-06 Impact factor: 4.226
Authors: Marco Paciotti; Paolo Casale; Piergiuseppe Colombo; Vittorio Fasulo; Alberto Saita; Giovanni Lughezzani; Roberto Contieri; Nicolò Maria Buffi; Massimo Lazzeri; Giorgio Guazzoni; Rodolfo Hurle Journal: Eur Urol Open Sci Date: 2021-02-24