title: Prognostic interest in discriminating muscularis mucosa invasion (T1a vs T1b) in nonmuscle invasive bladder carcinoma: French national multicenter study with central pathology review.
abstract: OBJECTIVE
  Predictive factors of T1 nonmuscle invasive bladder cancer evolution that could guide treatment decision making are lacking. We assessed the prognostic value of muscularis mucosa invasion in nonmuscle invasive bladder cancer.
  
  
  METHODS
  In a national multicenter study patients with primary T1 nonmuscle invasive bladder cancer were recruited from 6 French hospitals. All patients had undergone transurethral resection of bladder tumor. All T1 tumors were substaged according to muscularis mucosa invasion as T1a-no invasion beyond the muscularis mucosa or T1b-invasion beyond the muscularis mucosa with muscle preservation. Subsequent central pathology review was then done by a single referent uropathologist. Muscularis mucosa invasion was tested as a prognostic factor for survival on univariate and multivariate analysis.
  
  
  RESULTS
  A total of 587 patients were enrolled in the study, including 388 (66%) with T1a and 199 (34%) with T1b tumors. Median followup after transurethral resection of bladder tumor was 35 months (IQR 14-54). There was no significant difference between groups T1a and T1b except high tumor grade in T1b cases (p <0.0001). After central review, initial pathological substaging was confirmed in 84% of cases. On multivariate analysis muscularis mucosa invasion (T1b substage) was significantly associated with recurrence-free (p = 0.03), progression-free (p = 0.0002) and cancer specific (p = 0.02) survival. The main study limitation was absent systematic subsequent transurethral resection of bladder tumor.
  
  
  CONCLUSIONS
  Muscularis mucosa invasion appears to be highly predictive of T1 nonmuscle invasive bladder cancer behavior. Consequently, systematic T1a vs T1b discrimination should be highly advocated by urologists and pathologists. We believe that it could aid in crucial decision making when choosing between conservative management and radical cystectomy remains a moot point.
authors.affiliation: Academic Departments of Urology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. morgan.roupret@psl.aphp.fr
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Thomas
authors.initials: T
authors.lastname: Seisen
authors.forename: Eva
authors.initials: E
authors.lastname: Compérat
authors.forename: Stéphane
authors.initials: S
authors.lastname: Larré
authors.forename: Catherine
authors.initials: C
authors.lastname: Mazerolles
authors.forename: Françoise
authors.initials: F
authors.lastname: Gobet
authors.forename: Franck
authors.initials: F
authors.lastname: Fetissof
authors.forename: Gaelle
authors.initials: G
authors.lastname: Fromont
authors.forename: Athmane
authors.initials: A
authors.lastname: Safsaf
authors.forename: Benjamin Faivre
authors.initials: BF
authors.lastname: d'Arcier
authors.forename: Olivier
authors.initials: O
authors.lastname: Celhay
authors.forename: Pierre
authors.initials: P
authors.lastname: Validire
authors.forename: François
authors.initials: F
authors.lastname: Rozet
authors.forename: Jacques
authors.initials: J
authors.lastname: Irani
authors.forename: Michel
authors.initials: M
authors.lastname: Soulié
authors.forename: Christian
authors.initials: C
authors.lastname: Pfister
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001707:Biopsy, Needle; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy / Q000379:methods; D003558:Cystoscopy / Q000379:methods; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009092:Mucous Membrane / Q000473:pathology; D015999:Multivariate Analysis; D009130:Muscle, Smooth / Q000473:pathology*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery