Urologic oncology · 2025
Prognostic role of pathological substaging in high-grade pT1 bladder cancer undergoing BCG therapy: Insights on recurrence and progression.
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Kayar Kemal, Kayar Ridvan, Karabay Emre, Ozdemir Bugrahan Buhur, Tosun Cagatay, Gumrukcu Gulistan, Ozturk Metin Ishak, Yucebas Omer Ergin
Аннотация
INTRODUCTION/OBJECTIVES: Bladder cancer is a common malignancy, with pT1 tumors carrying a higher risk of recurrence and progression compared to other non-muscle-invasive bladder cancers (NMIBC). Substaging of pT1 tumors into superficial (pT1a) and deeper (pT1b) invasion into the lamina propria has shown potential prognostic value. This study investigates the impact of pT1 substaging on predicting progression and recurrence in patients with high-grade pT1 bladder cancer treated with Bacillus Calmette-Guérin (BCG) therapy.
MATERIALS AND METHODS: A retrospective analysis was conducted on 99 patients with primary high-grade pT1 bladder cancer who underwent transurethral resection of the bladder tumor (TURBT) followed by BCG therapy. Patients were stratified into pT1a and pT1b subgroups based on pathological findings. Predictors of disease progression and recurrence were assessed using logistic regression, adjusting for age, tumor size, carcinoma in situ (CIS), and multiplicity.
RESULTS: Of the 99 patients, 71.7% were classified as pT1a, and 28.3% as pT1b. Disease progression was significantly more frequent in pT1b cases (P < 0.001), particularly in the presence of concurrent CIS (P = 0.002). Logistic regression identified pT1b substaging (odds ratio [OR]: 28.9, 95% confidence interval [CI]: 12.4-58.7) and CIS (OR: 8.65, 95% CI: 3.21-18.8) as independent predictors of progression.
DISCUSSION: Pathological substaging of pT1 bladder cancer provides critical prognostic insights. Patients with pT1b tumors, especially those with concurrent CIS, are at higher risk for disease progression and may benefit from intensified management strategies. Incorporating pT1 substaging into routine pathological evaluations can improve risk stratification and inform individualized treatment planning.
MATERIALS AND METHODS: A retrospective analysis was conducted on 99 patients with primary high-grade pT1 bladder cancer who underwent transurethral resection of the bladder tumor (TURBT) followed by BCG therapy. Patients were stratified into pT1a and pT1b subgroups based on pathological findings. Predictors of disease progression and recurrence were assessed using logistic regression, adjusting for age, tumor size, carcinoma in situ (CIS), and multiplicity.
RESULTS: Of the 99 patients, 71.7% were classified as pT1a, and 28.3% as pT1b. Disease progression was significantly more frequent in pT1b cases (P < 0.001), particularly in the presence of concurrent CIS (P = 0.002). Logistic regression identified pT1b substaging (odds ratio [OR]: 28.9, 95% confidence interval [CI]: 12.4-58.7) and CIS (OR: 8.65, 95% CI: 3.21-18.8) as independent predictors of progression.
DISCUSSION: Pathological substaging of pT1 bladder cancer provides critical prognostic insights. Patients with pT1b tumors, especially those with concurrent CIS, are at higher risk for disease progression and may benefit from intensified management strategies. Incorporating pT1 substaging into routine pathological evaluations can improve risk stratification and inform individualized treatment planning.