膀胱癌T1次分級能預測表淺性膀胱癌預後
陳昱光1、林子平1,2、張延驊1,2、郭俊逸1,2、鍾孝仁1,2、吳宏豪1,2、
黃逸修1,2、林志杰1,2、范玉華1,2、黃奕燊1,2、呂仕彥3、林登龍1,2、
黃志賢1,2
台北榮民總醫院泌尿部1；國立陽明大學醫學院泌尿學科及書田泌尿科學研究中心2；台北榮民總醫院新竹分院外科部3
T1 substage in superficial bladder urothelial carcinoma can predict progression free survival
Yu-Kuang Chen1, Tzu-Ping Lin1,2, Yen-Hwa Chang1,2, Junne Yih Kuo1,2,
Hsiao-Jen Chung1,2, Howard H.H Wu1,2, Eric Yi-Hsiu Huang1,2, Chi-Cheh Lin1,2,
Y.H. Fan1,2, I-shen Huang1,2, Shih-Yen Lu3, Alex T.L. Lin1,2, William J. Huang1,2
Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan1,
Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center, National Yang-Ming University, Taipei, Taiwan2, Department of Surgery, Taipei Veterans General Hospital Hsinchu branch, Hsinchu, Taiwan3
Purpose
For urothelial bladder cancer, the depth of tumor invasion and tumor grade affect prognosis significantly. Among superficial urothelial carcinomas (UC) of the urinary bladder, T1 UC have much variable clinical presentation and course, but there is no consensus in substaging system in these patients. We analyzed the outcomes of focal and extensive T1 substaging according to the depth of lamina propria invasion (1.0 mm as cut off value) in out institute.
Materials and Methods
From 2007 to 2015, patients with pathology report of focal (≤ 1.0 mm) and extensive (>1.0 mm) T1 high grade bladder urothelial carcinoma (UC) were enrolled retrospectively. Patients with history of primary (pure) CIS, muscle invasive or upper tract UC were excluded. Clinical variables including demographic data, pathological grading and staging, recurrence was retrieved in hospital information system. The definition of recurrence was reappearance of UC in the bladder, and progression was advancing in stage, metastasis or death caused by UC. Outcomes including recurrence free survival, progression free survival, cancer specific and overall survival were analyzed with Kaplan-Meier method.
Results
A total of 363 patients were in the cohort, with 55-month follow-up in average. The mean age was 74 (±12.0) years old. One hundred and thirty-eight (38%) patient were classified as T1 focal substage, and 225 patients were T1 extensive. There were no significant differences in the demographic variables including sex, age, smoking or medical comorbidity between the two groups. With Kaplan-Meier survival analysis, progression free survival was significant shorter (p=0.024, log-rank test) in T1 extensive group, but we were unable to demonstrate a difference in recurrence free survival (p=0.168), cancer specific (p=0.102) or overall (p=0.515) survival between two groups.
Conclusions
In our single institute cohort, extensive T1 predicted shorter progression free survival as compared with focal T1.