Feasibility and Clinical Roles of Different Substaging Systems at First and Second Transurethral Resection in...

Area of Science:

• Uro-oncology
• Pathology
• Cancer Staging

Background:

• Decision-making for T1 high-grade bladder cancer is complex.
• Accurate staging is crucial for effective treatment planning and prognosis.

Purpose of the Study:

• To evaluate the feasibility and prognostic value of three bladder cancer substaging systems.
• To assess these systems on both primary and repeat transurethral resection (TUR) specimens.

Main Methods:

• Compared three microstaging systems: T1a/T1b/T1c, T1m/T1e (0.5-mm invasion), and the Rete Oncologica Lombarda (ROL) system (1-mm invasion).
• Assessed feasibility on first and second TUR specimens from 250 T1 high-grade bladder tumors.
• Used univariable Cox regression and Kaplan-Meier curves to analyze recurrence and progression.

Main Results:

• The ROL system demonstrated high feasibility on both first and second TUR specimens.
• The ROL substage (ROL2 vs ROL1) was the sole statistically significant predictor of progression (HR: 2.01, p<0.03).
• Feasibility of T1m/T1e and ROL systems was high.

Conclusions:

• T1 microstaging is feasible using various methods on both primary and repeat TUR specimens.
• The ROL system shows promise as a feasible and predictive tool for T1 high-grade bladder cancer.
• Further research is needed to define the clinical role of microstaging on repeat TUR specimens.