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T1G1 Bladder Cancer: Prognosis for this Rare Pathological Diagnosis Within the Non-muscle-invasive Bladder Cancer Spectrum
IJ. Beijert, AE. Hentschel, J. Bründl, EM. Compérat, K. Plass, O. Rodríguez, JD. Subiela Henríquez, V. Hernández, E. de la Peña, I. Alemany, D. Turturica, F. Pisano, F. Soria, O. Čapoun, L. Bauerová, M. Pešl, H. Maxim Bruins, W. Runneboom, S....
Jazyk angličtina Země Nizozemsko
Typ dokumentu časopisecké články
- MeSH
- lidé MeSH
- nádory močového měchýře neinvadující svalovinu * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: The pathological existence and clinical consequence of stage T1 grade 1 (T1G1) bladder cancer are the subject of debate. Even though the diagnosis of T1G1 is controversial, several reports have consistently found a prevalence of 2-6% G1 in their T1 series. However, it remains unclear if T1G1 carcinomas have added value as a separate category to predict prognosis within the non-muscle-invasive bladder cancer (NMIBC) spectrum. OBJECTIVE: To evaluate the prognostic value of T1G1 carcinomas compared to TaG1 and T1G2 carcinomas within the NMIBC spectrum. DESIGN, SETTING, AND PARTICIPANTS: Individual patient data for 5170 primary Ta and T1 bladder tumors from 17 hospitals in Europe and Canada were analyzed. Transurethral resection (TUR) was performed between 1990 and 2018. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Time to recurrence and progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox regression models stratified by institution. RESULTS AND LIMITATIONS: T1G1 represented 1.9% (99/5170) of all carcinomas and 5.3% (99/1859) of T1 carcinomas. According to primary TUR dates, the proportion of T1G1 varied between 0.9% and 3.5% per year, with similar percentages in the early and later calendar years. We found no difference in time to recurrence between T1G1 and TaG1 (p = 0.91) or between T1G1 and T1G2 (p = 0.30). Time to progression significantly differed between TaG1 and T1G1 (p < 0.001) but not between T1G1 and T1G2 (p = 0.30). Multivariable analyses for recurrence and progression showed similar results. CONCLUSIONS: The relative prevalence of T1G1 diagnosis was low and remained constant over the past three decades. Time to recurrence of T1G1 NMIBC was comparable to that for other stage/grade NMIBC combinations. Time to progression of T1G1 NMIBC was comparable to that for T1G2 but not for TaG1, suggesting that treatment and surveillance of T1G1 carcinomas should be more like the approaches for T1G2 NMIBC in accordance with the intermediate and/or high risk categories of the European Association of Urology NMIBC guidelines. PATIENT SUMMARY: Although rare, stage T1 grade 1 (T1G1) bladder cancer is still diagnosed in daily clinical practice. Using individual patient data from 17 centers in Europe and Canada, we found that time to progression of T1G1 cancer was comparable to that for T1G2 but not TaG1 cancer. Therefore, our results suggest that primary T1G1 bladder cancers should be managed with more aggressive treatment and more frequent follow-up than for low-risk bladder cancer.
Department of Health Evidence and Urology Radboud University Medical Center Nijmegen The Netherlands
Department of Pathology Fundacio Puigvert Universitat Autònoma de Barcelona Barcelona Spain
Department of Pathology Fundación Instituto Valenciano de Oncología Valencia Spain
Department of Pathology Hospital Universitario Fundación Alcorcón Madrid Spain
Department of Pathology Medical University of Graz Graz Austria
Department of Pathology Radboud University Medical Center Nijmegen The Netherlands
Department of Pathology Royal Free Hospital Royal Free London NHS Foundation Trust London UK
Department of Pathology Tenon Hospital AP HP Sorbonne University Paris France
Department of Pathology University of Regensburg Regensburg Germany
Department of Urology Caritas St Josef Medical Center University of Regensburg Regensburg Germany
Department of Urology Fundacio Puigvert Universitat Autònoma de Barcelona Barcelona Spain
Department of Urology Fundación Instituto Valenciano de Oncología Valencia Spain
Department of Urology Hospital Universitario Fundación Alcorcón Madrid Spain
Department of Urology Medical University of Graz Graz Austria
Department of Urology Radboud University Medical Center Nijmegen The Netherlands
Department of Urology Royal Free Hospital Royal Free London NHS Foundation Trust London UK
Department of Urology Tenon Hospital AP HP Sorbonne University Paris France
Department of Urology The Stokes Centre for Urology Royal Surrey Hospital Guildford UK
European Association of Urology Guidelines Office Board Arnhem The Netherlands
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- $a Beijert, Irene J $u Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
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- $a T1G1 Bladder Cancer: Prognosis for this Rare Pathological Diagnosis Within the Non-muscle-invasive Bladder Cancer Spectrum / $c IJ. Beijert, AE. Hentschel, J. Bründl, EM. Compérat, K. Plass, O. Rodríguez, JD. Subiela Henríquez, V. Hernández, E. de la Peña, I. Alemany, D. Turturica, F. Pisano, F. Soria, O. Čapoun, L. Bauerová, M. Pešl, H. Maxim Bruins, W. Runneboom, S. Herdegen, J. Breyer, A. Brisuda, A. Calatrava, J. Rubio-Briones, M. Seles, S. Mannweiler, J. Bosschieter, VRM. Kusuma, D. Ashabere, N. Huebner, J. Cotte, LS. Mertens, A. Masson-Lecomte, F. Liedberg, D. Cohen, L. Lunelli, O. Cussenot, S. El Sheikh, D. Volanis, JF. Côté, M. Rouprêt, A. Haitel, SF. Shariat, AH. Mostafid, JA. Nieuwenhuijzen, R. Zigeuner, JL. Dominguez-Escrig, J. Hacek, AR. Zlotta, M. Burger, M. Evert, CA. Hulsbergen-van de Kaa, AG. van der Heijden, L. A L M Kiemeney, V. Soukup, L. Molinaro, P. Gontero, C. Llorente, F. Algaba, J. Palou, J. N'Dow, MJ. Ribal, TH. van der Kwast, M. Babjuk, RJ. Sylvester, BWG. van Rhijn
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- $a BACKGROUND: The pathological existence and clinical consequence of stage T1 grade 1 (T1G1) bladder cancer are the subject of debate. Even though the diagnosis of T1G1 is controversial, several reports have consistently found a prevalence of 2-6% G1 in their T1 series. However, it remains unclear if T1G1 carcinomas have added value as a separate category to predict prognosis within the non-muscle-invasive bladder cancer (NMIBC) spectrum. OBJECTIVE: To evaluate the prognostic value of T1G1 carcinomas compared to TaG1 and T1G2 carcinomas within the NMIBC spectrum. DESIGN, SETTING, AND PARTICIPANTS: Individual patient data for 5170 primary Ta and T1 bladder tumors from 17 hospitals in Europe and Canada were analyzed. Transurethral resection (TUR) was performed between 1990 and 2018. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Time to recurrence and progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox regression models stratified by institution. RESULTS AND LIMITATIONS: T1G1 represented 1.9% (99/5170) of all carcinomas and 5.3% (99/1859) of T1 carcinomas. According to primary TUR dates, the proportion of T1G1 varied between 0.9% and 3.5% per year, with similar percentages in the early and later calendar years. We found no difference in time to recurrence between T1G1 and TaG1 (p = 0.91) or between T1G1 and T1G2 (p = 0.30). Time to progression significantly differed between TaG1 and T1G1 (p < 0.001) but not between T1G1 and T1G2 (p = 0.30). Multivariable analyses for recurrence and progression showed similar results. CONCLUSIONS: The relative prevalence of T1G1 diagnosis was low and remained constant over the past three decades. Time to recurrence of T1G1 NMIBC was comparable to that for other stage/grade NMIBC combinations. Time to progression of T1G1 NMIBC was comparable to that for T1G2 but not for TaG1, suggesting that treatment and surveillance of T1G1 carcinomas should be more like the approaches for T1G2 NMIBC in accordance with the intermediate and/or high risk categories of the European Association of Urology NMIBC guidelines. PATIENT SUMMARY: Although rare, stage T1 grade 1 (T1G1) bladder cancer is still diagnosed in daily clinical practice. Using individual patient data from 17 centers in Europe and Canada, we found that time to progression of T1G1 cancer was comparable to that for T1G2 but not TaG1 cancer. Therefore, our results suggest that primary T1G1 bladder cancers should be managed with more aggressive treatment and more frequent follow-up than for low-risk bladder cancer.
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