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Ceachi B, Cioplea M, Mustatea P, Gerald Dcruz J, Zurac S, Cauni V, Popp C, Mogodici C, Sticlaru L, Cioroianu A, Busca M, Stefan O, Tudor I, Dumitru C, Vilaia A, Oprisan A, Bastian A, Nichita L. A New Method of Artificial-Intelligence-Based Automatic Identification of Lymphovascular Invasion in Urothelial Carcinomas. Diagnostics (Basel) 2024; 14:432. [PMID: 38396472 PMCID: PMC10888137 DOI: 10.3390/diagnostics14040432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
The presence of lymphovascular invasion (LVI) in urothelial carcinoma (UC) is a poor prognostic finding. This is difficult to identify on routine hematoxylin-eosin (H&E)-stained slides, but considering the costs and time required for examination, immunohistochemical stains for the endothelium are not the recommended diagnostic protocol. We developed an AI-based automated method for LVI identification on H&E-stained slides. We selected two separate groups of UC patients with transurethral resection specimens. Group A had 105 patients (100 with UC; 5 with cystitis); group B had 55 patients (all with high-grade UC; D2-40 and CD34 immunohistochemical stains performed on each block). All the group A slides and 52 H&E cases from group B showing LVI using immunohistochemistry were scanned using an Aperio GT450 automatic scanner. We performed a pixel-per-pixel semantic segmentation of selected areas, and we trained InternImage to identify several classes. The DiceCoefficient and Intersection-over-Union scores for LVI detection using our method were 0.77 and 0.52, respectively. The pathologists' H&E-based evaluation in group B revealed 89.65% specificity, 42.30% sensitivity, 67.27% accuracy, and an F1 score of 0.55, which is much lower than the algorithm's DCC of 0.77. Our model outlines LVI on H&E-stained-slides more effectively than human examiners; thus, it proves a valuable tool for pathologists.
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Affiliation(s)
- Bogdan Ceachi
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Faculty of Automatic Control and Computer Science, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independenţei, Sector 6, 060042 Bucharest, Romania
| | - Mirela Cioplea
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Petronel Mustatea
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Department of Surgery, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania
| | - Julian Gerald Dcruz
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Sabina Zurac
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
| | - Victor Cauni
- Department of Urology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania
| | - Cristiana Popp
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Cristian Mogodici
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Liana Sticlaru
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Alexandra Cioroianu
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
| | - Mihai Busca
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
| | - Oana Stefan
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
| | - Irina Tudor
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
| | - Carmen Dumitru
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
| | - Alexandra Vilaia
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
| | - Alexandra Oprisan
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
- Department of Neurology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania
| | - Alexandra Bastian
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
| | - Luciana Nichita
- Department of Pathology, Colentina University Hospital, 21 Stefan Cel Mare Str., Sector 2, 020125 Bucharest, Romania; (B.C.); (M.C.); (C.P.); (C.M.); (L.S.); (A.C.); (M.B.); (O.S.); (I.T.); (C.D.); (A.V.); (A.B.); (L.N.)
- Zaya Artificial Intelligence, 9A Stefan Cel Mare Str., Voluntari, 077190 Ilfov, Romania; (P.M.); (J.G.D.)
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu Str., Sector 1, 020021 Bucharest, Romania;
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Lopez-Beltran A, Raspollini MR, Hansel D, Compérat E, Williamson SR, Liedberg F, Iczkowski KA, Bubendorf L, van der Kwast TH, Cheng L. International Society of Urological Pathology (ISUP) Consensus Conference on Current Issues in Bladder Cancer: Working Group 3: Subcategorization of T1 Bladder Cancer. Am J Surg Pathol 2024; 48:e24-e31. [PMID: 37737692 DOI: 10.1097/pas.0000000000002121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Emerging data on T1 bladder cancer subcategorization (aka substaging) suggests a correlation with oncological outcomes. The International Society of Urological Pathology (ISUP) organized the 2022 consensus conference in Basel, Switzerland to focus on current issues in bladder cancer and tasked working group 3 to make recommendations for T1 subcategorization in transurethral bladder resections. For this purpose, the ISUP developed and circulated a survey to their membership querying approaches to T1 bladder cancer subcategorization. In particular, clinical relevance, pathological reporting, and endorsement of T1 subcategorization in the daily practice of pathology were surveyed. Of the respondents of the premeeting survey, about 40% do not routinely report T1 subcategory. We reviewed literature on bladder T1 subcategorization, and screened selected articles for clinical performance and practicality of T1 subcategorization methods. Published literature offered evidence of the clinical rationale for T1 subcategorization and at the conference consensus (83% of conference attendants) was obtained to report routinely T1 subcategorization of transurethral resections. Semiquantitative T1 subcategorization was favored (37%) over histoanatomic methods (4%). This is in line with literature findings on practicality and prognostic impact, that is, a shift of publications from histoanatomic to semiquantitative methods or by reports incorporating both methodologies is apparent over the last decade. However, 59% of participants had no preference for either methodology. They would add a comment in the report briefly stating applied method, interpretation criteria (including cutoff), and potential limitations. When queried on the terminology of T1 subcategorization, 34% and 20% of participants were in favor of T1 (microinvasive) versus T1 (extensive) or T1 (focal) versus T1 (nonfocal), respectively.
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Affiliation(s)
- Antonio Lopez-Beltran
- Department of Morphological Sciences, Cordoba University Medical School, Cordoba, Spain
| | | | - Donna Hansel
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Fredrik Liedberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | | | - Lukas Bubendorf
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Theodorus H van der Kwast
- Laboratory Medicine Program, University Health Network and Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School; Lifespan Academic Medical Center, and the Legorreta Cancer Center at Brown University, Providence, RI
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Aron M, Zhou M. Urothelial Carcinoma: Update on Staging and Reporting, and Pathologic Changes Following Neoadjuvant Chemotherapies. Surg Pathol Clin 2022; 15:661-679. [PMID: 36344182 DOI: 10.1016/j.path.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Staging and reporting of cancers of the urinary tract have undergone major changes in the past decade to meet the needs for improved patient management. Substantial progress has been made. There, however, remain issues that require further clarity, including the substaging of pT1 tumors, grading and reporting of tumors with grade heterogeneity, and following NAC. Multi-institutional collaborative studies with prospective data will further inform the accurate diagnosis, staging, and reporting of these tumors, and in conjunction with genomic data will ultimately contribute to precision and personalized patient management.
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Affiliation(s)
- Manju Aron
- Department of Pathology, Keck School of Medicine, University of Southern California; Department of Urology, Keck School of Medicine, University of Southern California.
| | - Ming Zhou
- Department of Anatomic and Clinical Pathology, Tufts University School of Medicine and Tufts Medical Center, 800 Washington St., Box 802, Boston, MA 02111
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Yoneda K, Kamiya N, Utsumi T, Wakai K, Oka R, Endo T, Yano M, Hiruta N, Ichikawa T, Suzuki H. Impact of Lymphovascular Invasion on Prognosis in the Patients with Bladder Cancer-Comparison of Transurethral Resection and Radical Cystectomy. Diagnostics (Basel) 2021; 11:diagnostics11020244. [PMID: 33557407 PMCID: PMC7915441 DOI: 10.3390/diagnostics11020244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 02/08/2023] Open
Abstract
(1) Background: This study aimed to evaluate the associations of lymphovascular invasion (LVI) at first transurethral resection of bladder (TURBT) and radical cystectomy (RC) with survival outcomes, and to evaluate the concordance between LVI at first TURBT and RC. (2) Methods: We analyzed 216 patients who underwent first TURBT and 64 patients who underwent RC at Toho University Sakura Medical Center. (3) Results: LVI was identified in 22.7% of patients who underwent first TURBT, and in 32.8% of patients who underwent RC. Univariate analysis identified ≥cT3, metastasis and LVI at first TURBT as factors significantly associated with overall survival (OS) and cancer-specific survival (CSS). Multivariate analysis identified metastasis (hazard ratio (HR) 6.560, p = 0.009) and LVI at first TURBT (HR 9.205, p = 0.003) as significant predictors of CSS. On the other hand, in patients who underwent RC, ≥pT3, presence of G3 and LVI was significantly associated with OS and CSS in univariate analysis. Multivariate analysis identified inclusion of G3 as a significant predictor of OS and CSS. The concordance rate between LVI at first TURBT and RC was 48.0%. Patients with positive results for LVI at first TURBT and RC displayed poorer prognosis than other patients (p < 0.05). (4) Conclusions: We found that the combination of LVI at first TURBT and RC was likely to provide a more significant prognostic factor.
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Affiliation(s)
- Kei Yoneda
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba 285-8741, Japan; (K.Y.); (T.U.); (R.O.); (T.E.); (M.Y.); (H.S.)
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba 260-8687, Japan; (K.W.); (T.I.)
| | - Naoto Kamiya
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba 285-8741, Japan; (K.Y.); (T.U.); (R.O.); (T.E.); (M.Y.); (H.S.)
- Correspondence: ; Tel.: +81-43-462-8811
| | - Takanobu Utsumi
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba 285-8741, Japan; (K.Y.); (T.U.); (R.O.); (T.E.); (M.Y.); (H.S.)
| | - Ken Wakai
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba 260-8687, Japan; (K.W.); (T.I.)
| | - Ryo Oka
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba 285-8741, Japan; (K.Y.); (T.U.); (R.O.); (T.E.); (M.Y.); (H.S.)
| | - Takumi Endo
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba 285-8741, Japan; (K.Y.); (T.U.); (R.O.); (T.E.); (M.Y.); (H.S.)
| | - Masashi Yano
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba 285-8741, Japan; (K.Y.); (T.U.); (R.O.); (T.E.); (M.Y.); (H.S.)
| | - Nobuyuki Hiruta
- Department of Surgical Pathology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba 285-8741, Japan;
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba 260-8687, Japan; (K.W.); (T.I.)
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba 285-8741, Japan; (K.Y.); (T.U.); (R.O.); (T.E.); (M.Y.); (H.S.)
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Yoneda K, Utsumi T, Wakai K, Oka R, Endo T, Yano M, Kamiya N, Hiruta N, Suzuki H. Preoperative Clinical Predictors of Lymphovascular Invasion of Bladder Tumors at Transurethral Resection Pathology. Curr Urol 2020; 14:135-141. [PMID: 33224006 DOI: 10.1159/000499247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background The assessment of lymphovascular invasion (LVI) on the specimens of a transurethral resection of bladder tumors (TURBT) is very important for risk stratification and decision-making on further treatment for bladder cancer. Objectives The present study aimed to identify clinical predictors associated with the risk of bladder cancer with LVI before a first TURBT. Methods A total of 291 patients underwent a first TURBT for bladder cancer at Toho University Sakura Medical Center between January 2012 and December 2016. We analyzed predictors of LVI based on data from 217 patients and predictors of high grade and ≥ pT1 tumors based on data from the medical records of 237 patients for comparison with LVI risk factors. Results Univariate analysis significantly associated LVI with episodes of gross hematuria, positive urinary cytology, and larger, non-papillary and sessile tumors. Multivariate analysis selected larger tumors [odds ratio (OR) 1.39; 95 % confidence interval (CI) 1.08-1.78; p = 0.01], and non-papillary (OR 10.05; 95% CI 3.75-26.91; p < 0.01) and sessile (OR 2.65; 95% CI 1.18-5.93; p = 0.02) tumors as significant predictors of LVI. Some predictors such as tumor size and non-papillary tumors overlapped between high-grade and ≥ pT1 bladder cancer. Conclusions These predictors can help clinicians to identify patients with, or who are at high-risk for LVI before undergoing a first TURBT and to determine priorities for preoperative evaluation and scheduling consecutive treatments.
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Affiliation(s)
- Kei Yoneda
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Takanobu Utsumi
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Ken Wakai
- Department of Urology, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba
| | - Ryo Oka
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Takumi Endo
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Masashi Yano
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Naoto Kamiya
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Nobuyuki Hiruta
- Department of Surgical Pathology, Toho University Sakura Medical Center, Shimoshizu, Sakura, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
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Raspollini MR, Montironi R, Mazzucchelli R, Cimadamore A, Cheng L, Lopez-Beltran A. pT1 high-grade bladder cancer: histologic criteria, pitfalls in the assessment of invasion, and substaging. Virchows Arch 2020; 477:3-16. [PMID: 32296929 DOI: 10.1007/s00428-020-02808-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 12/18/2022]
Abstract
Most patients with bladder carcinoma are diagnosed with non-muscle-invasive disease, stage Ta, and pT1. Stage remains as the single most important prognostic indicator in urothelial carcinoma. Among the pT1 bladder cancer patients, recurrence and progression of disease occur in 50% and 10%, respectively. The identification of high-risk patients within the pT1 subgroup remains an important clinical goal and an active field of research. Substaging of pT1 disease has been claimed as important histologic discriminator by the 2016 World Health Organization (WHO) classification of the genitourinary tract tumors and by the 8th edition of the American Joint Committee on Cancer (AJCC) staging manual supporting its implementation in clinical practice. Interobserver variation in pT1 diagnosis and the associated pitfalls in pT1 assessment are the critical pathological issues. The aim of this review paper is to provide the practicing pathologist with the state of the art of morphological and immunohistochemical features useful for the diagnosis of early invasive bladder carcinomas, including practical clues on how to avoid relevant interpretative pitfalls, and to summarize the current status of pT1 substaging.
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Affiliation(s)
- Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, University Hospital Careggi, Viale Pieraccini, 6, 50139, Florence, Italy.
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Roberta Mazzucchelli
- Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Antonio Lopez-Beltran
- Unit of Anatomic Pathology, Department of Surgery, Cordoba University Medical School, Cordoba, Spain.,Champalimaud Clinical Center, Lisbon, Portugal
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Abstract
Stage T1 bladder cancers invade the lamina propria of the bladder and, despite sharing many of the genetic features of muscle-invasive bladder cancers, are classified as non-muscle-invasive or 'superficial' tumours. Yet, patients with T1 bladder cancer have an overall mortality of 33% and a cancer-specific mortality of 14% at three years after diagnosis, suggesting that these patients have a high risk of progression and, accordingly, require meticulous surgery, endoscopic surveillance and clinical decision-making. We hypothesize that the variability in the outcomes of patients with T1 bladder cancer is a result of both tumour heterogeneity and pathological staging, as well as inconsistencies in risk stratification, endoscopic resection and schedules of delivery of BCG. Owing to limitations in clinical staging, patients with T1 bladder cancer are at risk of both undertreatment with persistent use of BCG despite recurrence, and overtreatment with early cystectomy. Understanding the molecular features of T1 bladder cancers and how they respond to BCG therapy could improve biomarkers for risk stratification to align therapy with biological risk.
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Kardoust Parizi M, Enikeev D, Glybochko PV, Seebacher V, Janisch F, Fajkovic H, Chłosta PL, Shariat SF. Prognostic value of T1 substaging on oncological outcomes in patients with non-muscle-invasive bladder urothelial carcinoma: a systematic literature review and meta-analysis. World J Urol 2019; 38:1437-1449. [PMID: 31493109 PMCID: PMC7245585 DOI: 10.1007/s00345-019-02936-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/28/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose To evaluate the prognostic value of substaging on oncological outcomes in patients with T (or pT1) urothelial carcinoma of the bladder. Methods A literature search using PubMed, Scopus, Web of Science, and Cochrane Library was conducted on March 2019 to identify relevant studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. The pooled disease recurrence (DR) and disease progression (DP) rate in T1(or pT1) patients were calculated using a fixed or random effects model. Results Overall 36 studies published between 1994 and 2018 including a total of 6781 bladder cancer patients with T1(or pT1) stage were selected for the systematic review and meta-analysis. Twenty-nine studies reported significant association between tumor infiltration depth or muscularis mucosa (MM) invasion and oncological outcomes. Totally 12 studies were included in the meta-analysis. MM invasion (T1a/b/c [or pT1a/b/c] or T1a/b [or pT1a/b] substaging system) was associated with DR (pooled HR: 1.23, 95%CI: 1.01–1.49) and DP (pooled HR: 2.61, 95%CI: 1.61–4.23). Tumor infiltration depth (T1 m/e [or pT1 m/e] substaging system) was also associated with DR (pooled HR: 1.49, 95%CI: 1.11–2.00) and DP (pooled HR: 3.29, 95%CI: 2.39–4.51). Conclusions T1(or pT1) substaging in patients with bladder cancer is of prognostic value as it is associated with oncologic outcomes. Inclusion of this factors into the clinical decision-making process of this heterogeneous tumor may improve outcomes, while avoiding over- and under-treatment for T1(or pT1) bladder cancer.
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Affiliation(s)
- Mehdi Kardoust Parizi
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Petr V Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Veronika Seebacher
- Department for Gynecology and Gynecologic Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Florian Janisch
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harun Fajkovic
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Piotr L Chłosta
- Department of Urology, Jagiellonian University, Medical College, Cracow, Poland
| | - Shahrokh F Shariat
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. .,Department of Urology, Weill Cornell Medical College, New York, NY, USA. .,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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9
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The Role and Importance of Timely Radical Cystectomy for High-Risk Non-muscle-Invasive Bladder Cancer. Cancer Treat Res 2019; 175:193-214. [PMID: 30168123 DOI: 10.1007/978-3-319-93339-9_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Non-muscle-invasive bladder cancer accounts for the majority of incident bladder cancers but is a heterogeneous disease with variation in clinical presentation, course, and outcomes. Risk stratification techniques have attempted to identify those at highest risk of cancer recurrence and progression to help personalize and individualize treatment options. Radical cystectomy during the optimal window of curability could improve cancer outcomes; however, identifying the disease and patient characteristics as well as the correct timing to intervene remains difficult. We review the natural history of non-muscle-invasive bladder cancer, discuss different risk-stratification techniques and how they can help identify those most likely to benefit from radical treatment, and examine the evidence supporting the benefit of timely cystectomy.
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10
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Magers MJ, Lopez-Beltran A, Montironi R, Williamson SR, Kaimakliotis HZ, Cheng L. Staging of bladder cancer. Histopathology 2019; 74:112-134. [PMID: 30565300 DOI: 10.1111/his.13734] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Abstract
Urothelial carcinoma of the urinary bladder is a heterogeneous disease with multiple possible treatment modalities and a wide spectrum of clinical outcome. Treatment decisions and prognostic expectations hinge on accurate and precise staging, and the recently published American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition, should be the basis for staging of urinary bladder tumours. It is unfortunate that the International Union Against Cancer (UICC) 8th edition failed to incorporate new data which is considered in the AJCC 8th edition. Thus, the AJCC 8th edition is the focus of this review. Several critical changes and clarifications are made by the AJCC 8th edition relative to the 7th edition. Although the most obvious changes in the 8th edition are in the N (i.e. perivesical lymph node involvement now classified as N1) and M (i.e. M1 is subdivided into M1a and M1b) categories, several points are clarified in the T category (e.g. substaging of pT1 should be attempted). Further optimisation, however, is required. No particular method of substaging pT1 is formally recommended. In this review, these modifications are discussed, as well as points, which require further study and optimisation.
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Affiliation(s)
- Martin J Magers
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Antonio Lopez-Beltran
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Cordoba, Spain
| | - Rodolfo Montironi
- Faculty of Medicine, Department of Surgery, Unit of Anatomical Pathology, Cordoba, Spain.,Champalimaud Clinical Center, Lisbon, Portugal
| | - Sean R Williamson
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy.,Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
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11
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Mari A, Kimura S, Foerster B, Abufaraj M, D'Andrea D, Hassler M, Minervini A, Rouprêt M, Babjuk M, Shariat SF. A systematic review and meta-analysis of the impact of lymphovascular invasion in bladder cancer transurethral resection specimens. BJU Int 2018; 123:11-21. [PMID: 29807387 PMCID: PMC7379926 DOI: 10.1111/bju.14417] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of the present review was to assess the prognostic impact of lymphovascular invasion (LVI) in transurethral resection (TUR) of bladder cancer (BCa) specimens on clinical outcomes. A systematic review and meta-analysis of the available literature from the past 10 years was performed using MEDLINE, EMBASE and Cochrane library in August 2017. The protocol for this systematic review was registered on PROSPERO (Central Registration Depository: CRD42018084876) and is available in full on the University of York website. Overall, 33 studies (including 6194 patients) evaluating the presence of LVI at TUR were retrieved. LVI was detected in 17.3% of TUR specimens. In 19 studies, including 2941 patients with ≤cT1 stage only, LVI was detected in 15% of specimens. In patients with ≤cT1 stage, LVI at TUR of the bladder tumour (TURBT) was a significant prognostic factor for disease recurrence (pooled hazard ratio [HR] 1.97, 95% CI: 1.47-2.62) and progression (pooled HR 2.95, 95% CI: 2.11-4.13), without heterogeneity (I2 = 0.0%, P = 0.84 and I2 = 0.0%, P = 0.93, respectively). For patients with cT1-2 disease, LVI was significantly associated with upstaging at time of radical cystectomy (pooled odds ratio 2.39, 95% CI: 1.45-3.96), with heterogeneity among studies (I2 = 53.6%, P = 0.044). LVI at TURBT is a robust prognostic factor of disease recurrence and progression in non-muscle invasive BCa. Furthermore, LVI has a strong impact on upstaging in patients with organ-confined disease. The assessment of LVI should be standardized, reported, and considered for inclusion in the TNM classification system, helping clinicians in decision-making and patient counselling.
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Affiliation(s)
- Andrea Mari
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Shoji Kimura
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Beat Foerster
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Department of Special Surgery, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Melanie Hassler
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Morgan Rouprêt
- GRC no 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Marko Babjuk
- Department of Urology, Second Faculty of Medicine, Hospital Motol, Charles University, Praha, Czech Republic
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Weill Cornell Medical College, New York, NY, USA
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12
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Cogorno Wasylkowski L, Ríos-González E, Linares Espinós E, Leibar Tamayo A, Martínez-Piñeiro Lorenzo L. Indication for early cystectomy in nonmuscle-invasive bladder cancer. Literature review. Actas Urol Esp 2018; 42:17-24. [PMID: 28238343 DOI: 10.1016/j.acuro.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT High-risk nonmuscle-invasive bladder cancer is a disease that includes a heterogeneous group of patients, for whom close follow-up is recommended due to the risk of progression to a muscle-invasive tumour. The treatment of choice for these tumours is transurethral resection of the bladder tumour followed by a programme of bacillus Calmette-Guerin instillations. There is a subgroup of patients who have a greater risk of progression and who benefit from early radical treatment. OBJECTIVE To identify which patient group with nonmuscle-invasive bladder cancer will benefit from early radical treatment. SEARCHING THE EVIDENCE We performed a literature review to identify the risk factors for progression for these patients and thereby recommend a treatment that improves their survival rate. SYNTHESIS OF THE EVIDENCE We identified the various prognostic factors associated with tumour progression: the persistence of T1 tumour in re-resection of the bladder tumour, the presence of carcinoma in situ, patients refractory to bacillus Calmette-Guerin treatment, patients older than 70 years, tumours larger than 3cm, the substaging of T1 tumours, the presence of lymphovascular invasion and the presence of a tumour in the prostatic urethra. Similarly, we comment on the advantages of radical versus conservative treatment, considering that the performance of an early cystectomy due to a high-risk noninvasive vesical tumour has a better cancer prognosis than those in which the operation is deferred until the progression. CONCLUSIONS In this disease, it is important to individualise the patients to provide them personalized treatment. For patients with the previously mentioned characteristics, it is recommended that early cystectomy not be delayed.
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13
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Challenges in Pathologic Staging of Bladder Cancer: Proposals for Fresh Approaches of Assessing Pathologic Stage in Light of Recent Studies and Observations Pertaining to Bladder Histoanatomic Variances. Adv Anat Pathol 2017; 24:113-127. [PMID: 28398951 DOI: 10.1097/pap.0000000000000152] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The paradigm of pathologic stage (pT) categorization in bladder cancer remains the depth of invasion into the different histologic layers of the bladder wall. However, the approaches to assigning pT stage category toward an enhanced outcome stratification have been marked by challenges and innovations, due in part to our growing appreciation of the surprisingly perplexing bladder histoanatomy. Upstaging of pT1 tumors after radical cystectomy is substantial and underscores the potential value of pT1 substaging in transurethral resection (TUR) specimens. The 2017 American Joint Committee on Cancer tumor-node-metastasis system recommends pT1 substaging but recognizes the need to optimize the approach. Over the years, the cut-off for microinvasion has been significantly lowered to 0.5 mm and is now a promising scheme for pT1 (micrometric) substaging. Unlike the micrometric approach, histoanatomic substaging using muscularis mucosae (MM) and vascular plexus as landmarks is less feasible in TUR specimens and inconsistent in stratifying the outcome of pT1 tumors. The lamina propria possesses inherent variations in depth, MM, and vascular plexus dispositions that should be factored in future pT1 substaging proposals. Histoanatomic variations among the bladder regions also occur, and studies suggest that trigone and bladder neck cancers may have more adverse outcomes. The muscularis propria (MP), besides being the essential histologic landmark for assigning pT2 stage category, is also considered a surrogate for the adequacy of TUR, furthering the importance of identifying its presence in TUR specimens. MP, however, may be mimicked by hyperplastic or isolated MP-like MM muscle bundles in the lamina propria with overstaging implications, and caution should be exercised in distinguishing these 2 muscle types morphologically and immunohistochemically. Presence of additional superficial MP unique from the detrusor muscle proper may also complicate staging at the trigone and ureter insertion sites. With regard to the depth of MP invasion, large and multicenter studies have reaffirmed the prognostic significance of pT2a/b subcategories. It is revealed that there are at least 3 ways used to demarcate the irregular MP to perivesical soft tissue junction, and use of a common criterion indicates improvement in pT2b/pT3a staging reproducibility. Although studies have shown significantly poorer outcome in pT3b compared with pT3a tumors, this designation has a substantial reliance on the prosector's gross assessment of perivesical soft tissue invasion which if performed incorrectly may lead to staging inaccuracy of pT3 tumors. The 8th edition of the American Joint Committee on Cancer has updated the staging schema for bladder cancers with concomitant prostatic stromal invasion and cancers within bladder diverticula. Because of 2 possible pT designations, prostatic stromal invasion in TUR specimens should not be automatically staged as either pT4a or pT2 (urethral). Recent data support that bladder cancer invading into the seminal vesicle has comparable outcome to pT4b tumors. Interestingly, several studies in pT4a tumors, which are staged based on sex-specific organs, have shown poorer outcome in females than males after radical cystectomy, and while there are possibly several reasons, they may also include anatomic factors. Despite the progress has been made, work remains to be done to inform future bladder cancer pT category definitions and their reproducibility in application and prognostication.
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14
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Patschan O, Holmäng S, Hosseini A, Jancke G, Liedberg F, Ljungberg B, Malmström PU, Rosell J, Jahnson S. Second-look resection for primary stage T1 bladder cancer: a population-based study. Scand J Urol 2017; 51:301-307. [DOI: 10.1080/21681805.2017.1303846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Oliver Patschan
- Department of Translational Medicine, Lund University and Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Sten Holmäng
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Abolfazl Hosseini
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Georg Jancke
- Department of Translational Medicine, Lund University and Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Fredrik Liedberg
- Department of Translational Medicine, Lund University and Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Per-Uno Malmström
- Department of Urology, Akademiska University Hospital, Uppsala, Sweden
| | - Johan Rosell
- Regional Cancer Center Southeast Sweden and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Staffan Jahnson
- Department of Urology, University Hospital and IKE, Linköping University, Linköping, Sweden
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15
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Abstract
Outcome prediction in patients with bladder cancer has improved through the development of nomograms and predictive models. However, integration of further characteristics such as lymphovascular invasion (LVI) might increase the accuracy and clinical utility of these instruments. Assessment and reporting of LVI in specimens from transurethral resection of the bladder tumour (TURBT) or biopsy in patients with non-muscle-invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC) might enable improved staging, prognostication and clinical decision-making. In NMIBC, presence of LVI in TURBT and biopsy samples seems to be associated with understaging and increased risks of disease recurrence and progression. In MIBC, presence of LVI is associated with features of aggressive disease and predicts recurrence and survival. Integration of LVI status into predictive models might aid clinical decision-making regarding intravesical instillation schedules and regimens, early radical cystectomy in patients with high-grade T1 disease and perioperative chemotherapy. However, LVI assessment is hampered by insufficient reproducibility and reliability, lack of routine evaluation and limited concordance between findings in TURBT and radical cystectomy specimens. Standardization of the pathological criteria defining LVI is warranted to improve its reporting in routine clinical practice and its utility as a care-changing prognostic marker.
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16
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Prognostic significance of substage and WHO classification systems in T1 urothelial carcinoma of the bladder. Curr Opin Urol 2015; 25:427-35. [DOI: 10.1097/mou.0000000000000202] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Martin-Doyle W, Leow JJ, Orsola A, Chang SL, Bellmunt J. Improving Selection Criteria for Early Cystectomy in High-Grade T1 Bladder Cancer: A Meta-Analysis of 15,215 Patients. J Clin Oncol 2015; 33:643-50. [DOI: 10.1200/jco.2014.57.6967] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose High-grade T1 (HGT1) bladder cancer is the highest risk subtype of non–muscle-invasive bladder cancer, with highly variable prognosis, poorly understood risk factors, and considerable debate about the role of early cystectomy. We aimed to address these questions through a meta-analysis of outcomes and prognostic factors. Methods PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and American Society of Clinical Oncology abstracts were searched for cohort studies in HGT1. We pooled data on recurrence, progression, and cancer-specific survival from 73 studies. Results Five-year rates of recurrence, progression, and cancer-specific survival were 42% (95% CI, 39% to 45%), 21% (95% CI, 18% to 23%), and 87% (95% CI, 85% to 89%), respectively (56 studies, n = 15,215). In the prognostic factor meta-analysis (33 studies, n = 8,880), the highest impact risk factor was depth of invasion (T1b/c) into lamina propria (progression: hazard ratio [HR], 3.34; P < .001; cancer-specific survival: HR, 2.02; P = .001). Several other previously proposed factors also predicted progression and cancer-specific survival (lymphovascular invasion, associated carcinoma in situ, nonuse of bacillus Calmette-Guérin, tumor size > 3 cm, and older age; HRs for progression between 1.32 and 2.88, P ≤ .002; HRs for cancer-specific survival between 1.28 and 2.08, P ≤ .02). Conclusion In this large analysis of outcomes and prognostic factors in HGT1 bladder cancer, deep lamina propria invasion had the largest negative impact, and other previously proposed prognostic factors were also confirmed. These factors should be used for prognostication and patient stratification in future clinical trials, and depth of invasion should be considered for inclusion in TNM staging criteria. This meta-analysis can also help define selection criteria for early cystectomy in HGT1 bladder cancer, particularly for patients with deep lamina propria invasion combined with other risk factors.
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Affiliation(s)
- William Martin-Doyle
- William Martin-Doyle, University of Massachusetts Medical School, Worcester; Jeffrey J. Leow, Steven L. Chang, and Joaquim Bellmunt, Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School; Jeffrey J. Leow and Steven L. Chang, Brigham and Women's Hospital, Harvard Medical School; Anna Orsola, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Joaquim Bellmunt, University Hospital del Mar d'Investigacions Médiques, IMIM, Barcelona, Spain
| | - Jeffrey J. Leow
- William Martin-Doyle, University of Massachusetts Medical School, Worcester; Jeffrey J. Leow, Steven L. Chang, and Joaquim Bellmunt, Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School; Jeffrey J. Leow and Steven L. Chang, Brigham and Women's Hospital, Harvard Medical School; Anna Orsola, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Joaquim Bellmunt, University Hospital del Mar d'Investigacions Médiques, IMIM, Barcelona, Spain
| | - Anna Orsola
- William Martin-Doyle, University of Massachusetts Medical School, Worcester; Jeffrey J. Leow, Steven L. Chang, and Joaquim Bellmunt, Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School; Jeffrey J. Leow and Steven L. Chang, Brigham and Women's Hospital, Harvard Medical School; Anna Orsola, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Joaquim Bellmunt, University Hospital del Mar d'Investigacions Médiques, IMIM, Barcelona, Spain
| | - Steven L. Chang
- William Martin-Doyle, University of Massachusetts Medical School, Worcester; Jeffrey J. Leow, Steven L. Chang, and Joaquim Bellmunt, Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School; Jeffrey J. Leow and Steven L. Chang, Brigham and Women's Hospital, Harvard Medical School; Anna Orsola, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Joaquim Bellmunt, University Hospital del Mar d'Investigacions Médiques, IMIM, Barcelona, Spain
| | - Joaquim Bellmunt
- William Martin-Doyle, University of Massachusetts Medical School, Worcester; Jeffrey J. Leow, Steven L. Chang, and Joaquim Bellmunt, Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School; Jeffrey J. Leow and Steven L. Chang, Brigham and Women's Hospital, Harvard Medical School; Anna Orsola, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Joaquim Bellmunt, University Hospital del Mar d'Investigacions Médiques, IMIM, Barcelona, Spain
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18
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Kim HS, Kim M, Jeong CW, Kwak C, Kim HH, Ku JH. Presence of lymphovascular invasion in urothelial bladder cancer specimens after transurethral resections correlates with risk of upstaging and survival: A systematic review and meta-analysis. Urol Oncol 2014; 32:1191-9. [PMID: 24954108 DOI: 10.1016/j.urolonc.2014.05.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/14/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
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19
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Olsson H, Hultman P, Rosell J, Söderkvist P, Jahnson S. MDM2 SNP309 promoter polymorphism and p53 mutations in urinary bladder carcinoma stage T1. BMC Urol 2013; 13:5. [PMID: 23356517 PMCID: PMC3574032 DOI: 10.1186/1471-2490-13-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 01/16/2013] [Indexed: 12/28/2022] Open
Abstract
Background Urinary bladder carcinoma stage T1 is an unpredictable disease that in some cases has a good prognosis with only local or no recurrence, but in others can appear as a more aggressive tumor with progression to more advanced stages. The aim here was to investigate stage T1 tumors regarding MDM2 promoter SNP309 polymorphism, mutations in the p53 gene, and expression of p53 and p16 measured by immunohistochemistry, and subsequently relate these changes to tumor recurrence and progression. We examined a cohort of patients with primary stage T1 urothelial carcinoma of the bladder and their tumors. Methods After re-evaluation of the original slides and exclusions, the study population comprised 141 patients, all with primary stage T1 urothelial carcinoma of the bladder. The hospital records were screened for clinical parameters and information concerning presence of histologically proven recurrence and progression. The paraffin-embedded tumor material was evaluated by immunohistochemistry. Any mutations found in the p53 gene were studied by single-strand conformation analysis and Sanger sequencing. The MDM2 SNP309 polymorphism was investigated by pyrosequencing. Multivariate analyses concerning association with prognosis were performed, and Kaplan-Meier analysis was conducted for a combination of changes and time to progression. Results Of the 141 patients, 82 had at least one MDM2 SNP309 G allele, and 53 had a mutation in the p53 gene, but neither of those anomalies was associated with a worse prognosis. A mutation in the p53 gene was associated with immunohistochemically visualized p53 protein expression at a cut-off value of 50%. In the group with p53 mutation Kaplan-Meier analysis showed higher rate of progression and shorter time to progression in patients with immunohistochemically abnormal p16 expression compared to them with normal p16 expression (p = 0.038). Conclusions MDM2 SNP309 promoter polymorphism and mutations in p53 were not associated with worse prognosis in this cohort of patients with primary stage T1 urinary bladder carcinoma. However, patients with abnormal p16 expression and a mutated p53 gene had a higher rate of and a shorter time to progression, and p53 gene mutation was associated with an abnormal immunohistochemistry for p53 at a cut-off of 50%.
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Affiliation(s)
- Hans Olsson
- Molecular and Immunological Pathology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Clinical Pathology and Clinical Genetics, Östergötland County Council, Linköping, Sweden.
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20
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Olsson H, Hultman P, Monsef N, Rosell J, Jahnson S. Immunohistochemical evaluation of cell cycle regulators: impact on predicting prognosis in stage t1 urinary bladder cancer. ISRN UROLOGY 2012; 2012:379081. [PMID: 23304558 PMCID: PMC3523551 DOI: 10.5402/2012/379081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/17/2012] [Indexed: 12/20/2022]
Abstract
Background and Objective. The cell cycle is regulated by proteins at different checkpoints, and dysregulation of this cycle plays a role in carcinogenesis. Matrix metalloproteinases (MMPs) are enzymes that degrade collagen and promote tumour infiltration. The aim of this study was to evaluate the expression of various cell cycle regulators and MMPs and to correlate such expression with progression and recurrence in patients with stage T1 urothelial carcinoma of the bladder (UCB). Patients and Methods. This population-based cohort study comprised 201 well-characterized patients with primary stage T1 urothelial carcinoma of the bladder. Immunohistochemistry was performed on formalin-fixed material to quantify expression of cell cycle regulators and two MMPs. Results. Normal expression of p53 and abnormal expression of MMP9 were associated with greater risk of tumour recurrence. Also, normal p16 expression was related to a lower risk of tumour progression. MMP2, p21, cyclin D1, and pRb showed no significant results that could estimate progression or recurrence. Conclusions. Normal p16 expression is associated with a lower risk of tumour progression, but immunohistochemistry on cell cycle regulators and MMPs has little value in predicting the prognosis in stage T1 UCB.
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Affiliation(s)
- Hans Olsson
- Molecular and Immunological Pathology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Clinical Pathology and Clinical Genetics, County Council of Östergötland, 581 85 Linköping, Sweden
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