Is Tumor Budding a New Predictor for Early Cystectomy in pT1 High-Grade Bladder Cancer?

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• High-grade T1 (HGT1) tumors carry a risk of progression.
• Tumor budding (TB) is a histological feature defined as cancer cell clusters in the stroma.
• TB is a known predictor of lymph node metastasis in colorectal cancer.

Purpose of the Study:

• To evaluate the risk of progression in HGT1 tumors.
• To assess the utility of tumor budding (TB) and other clinical/histological features in predicting HGT1 progression.

Main Methods:

• Observational longitudinal cohort study of 168 HGT1 patients (2013-2016).
• Cox regression analysis to correlate features with progression.
• Blind assessment of slides by genitourinary pathologists; TB positive if ≥6 buds.

Main Results:

• Median follow-up: 35 months; 19.6% of patients progressed.
• Progression occurred in 32.7% of TB-positive vs. 14.3% of TB-negative patients (p=0.006).
• Multivariate analysis identified TB (HR 2.1), CIS, TP, and lack of BCG induction as significant predictors of progression.

Conclusions:

• Tumor budding (TB) is a significant, easily implementable pathological variable for predicting HGT1 tumor progression.
• Incorporating TB into the TNM system could aid early cystectomy decisions.
• TB offers valuable prognostic information for HGT1 tumors.