{"title":"pT1 亚分类预测膀胱肿瘤标本整体切除术的无进展生存期","authors":"Shun Sato, Takafumi Yanagisawa, Jun Miki, Yasushi Hayashida, Yohei Okada, Kosuke Iwatani, Akihiro Matsukawa, Takahiro Kimura, Shin Egawa, Masayuki Shimoda, Hiroyuki Takahashi","doi":"10.5858/arpa.2023-0044-OA","DOIUrl":null,"url":null,"abstract":"<p><strong>Context: </strong>The pathologic diagnosis of pT1 substage in conventional transurethral resection of bladder tumor specimens is inaccurate and has low interobserver reproducibility owing to fragmentation and cauterization of the specimens. En bloc resection of bladder tumor is a novel surgical procedure that improves diagnostic feasibility and accuracy in the pathologic diagnosis of bladder cancer, including depth and extent of invasion.</p><p><strong>Objective: </strong>To examine the prognostic value of multiple pT1 subclassification methods, using only en bloc resection specimens.</p><p><strong>Design: </strong>We examined 106 patients with T1 bladder cancer who underwent en bloc resection. The pT1 substages were assigned by 3 different subclassification methods by using the muscularis mucosae or stalk of the papillary lesion as diagnostic landmarks or millimetric depth of invasion. Intergroup differences in progression-free survival and recurrence-free survival rates were analyzed. The prognostic values of clinicopathologic factors for progression/recurrence were analyzed by using multivariate analysis.</p><p><strong>Results: </strong>The pT1 substage was evaluable in all cases. Tumors with invasion into/beyond the muscularis mucosae and those beyond the stalk of the papillary lesion were associated with worse progression-free survival (P = .002 and P = .01, respectively). Notably, no patient with invasion confined to the stalk had disease progression during the 23-month median follow-up period. Only the pT1 subclassification method using the muscularis mucosae was an independent prognosticator of progression in multivariate analysis (P = .03).</p><p><strong>Conclusions: </strong>Precise pathologic subclassification of invasion using en bloc resection specimens may enable accurate prognosis and assessment in patients with bladder cancer with suspicious shallow invasion.</p>","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"573-580"},"PeriodicalIF":3.7000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"pT1 Subclassification Predicts Progression-Free Survival in En Bloc Resection of Bladder Tumor Specimens.\",\"authors\":\"Shun Sato, Takafumi Yanagisawa, Jun Miki, Yasushi Hayashida, Yohei Okada, Kosuke Iwatani, Akihiro Matsukawa, Takahiro Kimura, Shin Egawa, Masayuki Shimoda, Hiroyuki Takahashi\",\"doi\":\"10.5858/arpa.2023-0044-OA\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Context: </strong>The pathologic diagnosis of pT1 substage in conventional transurethral resection of bladder tumor specimens is inaccurate and has low interobserver reproducibility owing to fragmentation and cauterization of the specimens. En bloc resection of bladder tumor is a novel surgical procedure that improves diagnostic feasibility and accuracy in the pathologic diagnosis of bladder cancer, including depth and extent of invasion.</p><p><strong>Objective: </strong>To examine the prognostic value of multiple pT1 subclassification methods, using only en bloc resection specimens.</p><p><strong>Design: </strong>We examined 106 patients with T1 bladder cancer who underwent en bloc resection. The pT1 substages were assigned by 3 different subclassification methods by using the muscularis mucosae or stalk of the papillary lesion as diagnostic landmarks or millimetric depth of invasion. Intergroup differences in progression-free survival and recurrence-free survival rates were analyzed. The prognostic values of clinicopathologic factors for progression/recurrence were analyzed by using multivariate analysis.</p><p><strong>Results: </strong>The pT1 substage was evaluable in all cases. Tumors with invasion into/beyond the muscularis mucosae and those beyond the stalk of the papillary lesion were associated with worse progression-free survival (P = .002 and P = .01, respectively). Notably, no patient with invasion confined to the stalk had disease progression during the 23-month median follow-up period. Only the pT1 subclassification method using the muscularis mucosae was an independent prognosticator of progression in multivariate analysis (P = .03).</p><p><strong>Conclusions: </strong>Precise pathologic subclassification of invasion using en bloc resection specimens may enable accurate prognosis and assessment in patients with bladder cancer with suspicious shallow invasion.</p>\",\"PeriodicalId\":8305,\"journal\":{\"name\":\"Archives of pathology & laboratory medicine\",\"volume\":\" \",\"pages\":\"573-580\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2024-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of pathology & laboratory medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5858/arpa.2023-0044-OA\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICAL LABORATORY TECHNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of pathology & laboratory medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5858/arpa.2023-0044-OA","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICAL LABORATORY TECHNOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:传统经尿道膀胱肿瘤切除术标本的病理诊断 pT1 亚分期不准确,而且由于标本破碎和烧灼,观察者之间的可重复性很低。膀胱肿瘤整体切除术是一种新型手术方法,可提高膀胱癌病理诊断的可行性和准确性,包括侵犯深度和范围:仅使用全切标本研究多种 pT1 亚分类方法的预后价值:我们对 106 名接受全切的 T1 膀胱癌患者进行了研究。采用3种不同的亚分类方法,以粘膜肌肉或乳头状病变的柄部作为诊断标志或以毫米为单位的浸润深度来划分pT1亚型。分析了无进展生存率和无复发生存率的组间差异。采用多变量分析法对临床病理因素对进展/复发的预后价值进行了分析:结果:所有病例的 pT1 亚分期均可评估。肿瘤侵犯粘膜肌层或超出粘膜肌层以及超出乳头状病变柄的肿瘤与较差的无进展生存期相关(分别为 P = .002 和 P = .01)。值得注意的是,在23个月的中位随访期间,没有一名侵犯范围局限于柄部的患者出现疾病进展。在多变量分析中,只有使用粘膜肌的pT1亚分类方法是疾病进展的独立预后指标(P = .03):结论:使用整体切除标本对侵犯进行精确的病理亚分类,可对可疑浅表侵犯的膀胱癌患者进行准确的预后和评估。
pT1 Subclassification Predicts Progression-Free Survival in En Bloc Resection of Bladder Tumor Specimens.
Context: The pathologic diagnosis of pT1 substage in conventional transurethral resection of bladder tumor specimens is inaccurate and has low interobserver reproducibility owing to fragmentation and cauterization of the specimens. En bloc resection of bladder tumor is a novel surgical procedure that improves diagnostic feasibility and accuracy in the pathologic diagnosis of bladder cancer, including depth and extent of invasion.
Objective: To examine the prognostic value of multiple pT1 subclassification methods, using only en bloc resection specimens.
Design: We examined 106 patients with T1 bladder cancer who underwent en bloc resection. The pT1 substages were assigned by 3 different subclassification methods by using the muscularis mucosae or stalk of the papillary lesion as diagnostic landmarks or millimetric depth of invasion. Intergroup differences in progression-free survival and recurrence-free survival rates were analyzed. The prognostic values of clinicopathologic factors for progression/recurrence were analyzed by using multivariate analysis.
Results: The pT1 substage was evaluable in all cases. Tumors with invasion into/beyond the muscularis mucosae and those beyond the stalk of the papillary lesion were associated with worse progression-free survival (P = .002 and P = .01, respectively). Notably, no patient with invasion confined to the stalk had disease progression during the 23-month median follow-up period. Only the pT1 subclassification method using the muscularis mucosae was an independent prognosticator of progression in multivariate analysis (P = .03).
Conclusions: Precise pathologic subclassification of invasion using en bloc resection specimens may enable accurate prognosis and assessment in patients with bladder cancer with suspicious shallow invasion.
期刊介绍:
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