MP65-14 PROPOSAL FOR INCLUDING SUBSTAGING OF HGT1 BLADDER CANCER IN THE TNM CLASSIFICATION: A SYSTEMATIC REVIEW AND META-ANALYSIS BASED ON 2678 PATIENTS (2014)

You have accessJournal of UrologyBladder Cancer: Staging1 Apr 2014MP65-14 PROPOSAL FOR INCLUDING SUBSTAGING OF HGT1 BLADDER CANCER IN THE TNM CLASSIFICATION: A SYSTEMATIC REVIEW AND META-ANALYSIS BASED ON 2678 PATIENTS Anna Orsola, William Martin-Doyle, Jeffrey J. Leow, and Joaquim Bellmunt Anna OrsolaAnna Orsola More articles by this author , William Martin-DoyleWilliam Martin-Doyle More articles by this author , Jeffrey J. LeowJeffrey J. Leow More articles by this author , and Joaquim BellmuntJoaquim Bellmunt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1911AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES During the past 20 years multiple efforts have been directed to risk stratify high grade (HG) T1 bladder cancer. The amount of invasion of the subepithelial connective tissue has been addressed through diverse approaches : invasion of muscularis mucosae (T1a, T1b/c), depth of invasion of lamina propria (cut-offs; 0.5, 1 and 1.5mm), T1-microinvasive vs T1-extensive-invasive (T1m, T1e), µmeters at the deepest point of invasion, etc. All systems have shown capability to differentiate tumors at higher risk of progression, but substaging is not yet fully established nor included in TNM. The present study intends to meta-analyze the impact of the diverse approaches and presents a systematic review of published reports focusing on progression (1ary outcome), as well as cancer-specific survival (CSS) and recurrence (2ary outcomes). METHODS A systematic review was conducted searching PubMed, Embase, the Cochrane library, and ASCO abstracts for substaging in T1 disease published until Sep2013. Studies meeting the following criteria were included in a random-effects model: ≥66% pts HGT1, with hazard ratios or number of events reported for substage. To pool studies using different approaches, study arms were reclassified as either less invasive or more invasive. RESULTS 21 studies were included with a total of 2678 T1 patients (94% HGT1). 18 of 21 publications reported progression according to invasion of muscularis mucosae (T1a, T1b/c), 3 according to T1m/T1e, 2 according to more or less than 1.5mm invasion, while 1 reported each of the other approaches. Long-term recurrence, progression, and cancer-specific mortality rates by more and less aggressive T1 substage are presented in the table. CONCLUSIONS Substaging HGT1 bladder cancer establishes two clear risk groups regardless of the method used, with an impact on progression as well as on CSS. Results particularly impact progression, with a highly significant two-fold elevation in risk of progression for the more aggressive arm, whereas recurrence did not vary among arms. The invasion of the muscularis mucosae simplified to the two tier system (T1a/T1b) is the most widely used method. Given this significant risk increase, addition of substaging HGT1 in the TNM classification should be carefully considered. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e696-e697 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Anna Orsola More articles by this author William Martin-Doyle More articles by this author Jeffrey J. Leow More articles by this author Joaquim Bellmunt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...