MP71-06 ONCOLOGICAL OUTCOMES AND PROGNOSTIC IMPLICATIONS OF T1 SUBSTAGING IN OVERALL MANAGEMENT OF HG NMIBC: RESULTS FROM A LARGE SINGLE CENTER

Field: Medicine (Health Sciences)

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP71)1 May 2024MP71-06 ONCOLOGICAL OUTCOMES AND PROGNOSTIC IMPLICATIONS OF T1 SUBSTAGING IN OVERALL MANAGEMENT OF HG NMIBC: RESULTS FROM A LARGE SINGLE CENTER Antonio Fanelli, Marco Finati, Francesco Pio Cinelli, Nicola Schiavone, Leonardo Martino, Oscar Selvaggio, Carlo Bettocchi, Gian Maria Busetto, Luigi Cormio, and Giuseppe Carrieri Antonio FanelliAntonio Fanelli , Marco FinatiMarco Finati , Francesco Pio CinelliFrancesco Pio Cinelli , Nicola SchiavoneNicola Schiavone , Leonardo MartinoLeonardo Martino , Oscar SelvaggioOscar Selvaggio , Carlo BettocchiCarlo Bettocchi , Gian Maria BusettoGian Maria Busetto , Luigi CormioLuigi Cormio , and Giuseppe CarrieriGiuseppe Carrieri View All Author Informationhttps://doi.org/10.1097/01.JU.0001009548.76580.ba.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A wide variation of recurrence and progression are observed among patients with high-grade (HG) T1 non-muscle-invasive bladder cancer (NMIBC). Despite the efforts of the European Association of Urology (EAU) NMIBC Committee, current risk calculators struggle to accurately predict prognosis among this heterogeneous group. Our study evaluated how T1 substaging may improve the overall management of these patients. METHODS: Our cohort enlisted 444 patients with a diagnosis of primary T1G3 BCa at our Institution. Data from diagnosis to subsequent repeated transurethral resection of bladder tumor (RE-TURBT), eventual bacillus Calmette-Guérin (BCG) treatment and follow-up were collected. All specimens were analyzed by two dedicated uropathologists. The population was stratified into T1a, Tumors cells invade above the Muscolaris Mucosa (MM), and T1b, they invade into or beyond the MM, for statistical analyses, whenever possible. Differences in medians and proportions were assessed using Wilcoxon–Mann–Whitney and Person chi-square test. Kaplan–Meier and multivariate Cox regression analyses regarding recurrence-free (RFS), progression-free (PFS) and cancer-specific survival (CSS) were performed. We included clinicopathological characteristics at first TURBT and BCG treatment as variables. RESULTS: The median age of patients at diagnosis was 75 years (interquartile range=66-81 years); 388 patients were male (87.4%) At first TURBT, patients with T1b disease had larger tumors (>3 cm: 55.4% vs. 36.6%, p=0.003) when compared with those with T1a. At RE-TURBT, residual HG BC was found in 23% of T1a and 14.5% of T1b (p=0.1), while pathological upstaging (≥T2) was shown in 1.3% with T1a vs. 6.6% with T1b (p=0.04). At a median follow-up of 40 months (interquartile range=17-72 months), recurrence-free survival was 39.7% for the T1a group and 38.8% for the T1b group. Progression was observed in 27 (11.2%) and 21 (18.1%) patients with T1a and T1b disease (p=0.07). Cancer-specific survival was 83% and 75%, while cystectomy was performed in 16.5% versus 19%, respectively. Overall, patients with T1b disease had worse survival curves when compared to those with T1a, albeit this reached statistical significance only for PFS (p=0.01). At multivariable analyses, an adequate BCG course was an independent predictor for all outcomes evaluated (all p<0.01), while T1 substaging did not independently predict any endpoints evaluated. CONCLUSIONS: Extensive invasion of the lamina propria in primary T1 NMIBC was associated with poorer overall PFS and higher risk of upstaging to MIBC at RE-TURBT. Even if T1 substaging alone is suboptimal for predicting oncological outcomes of HG T1 NMIBC, its combination with other factors (lymphovascular invasion, multifocality, associated carcinoma in situ, no prior BCG treatment, >3 cm tumor size, and older age) may improve risk stratification and guide overall management disease. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1162 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Antonio Fanelli More articles by this author Marco Finati More articles by this author Francesco Pio Cinelli More articles by this author Nicola Schiavone More articles by this author Leonardo Martino More articles by this author Oscar Selvaggio More articles by this author Carlo Bettocchi More articles by this author Gian Maria Busetto More articles by this author Luigi Cormio More articles by this author Giuseppe Carrieri More articles by this author Expand All Advertisement PDF downloadLoading ...