Multiple Adverse Histological Features Increase The Odds Of Under Staging T1 Bladder Cancer

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 16 Aug 2009 - 0:00 PDT

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UroToday.com - Patients with T1 bladder cancer have an uncertain natural history. It is clear that patients who are allowed to progress to muscle invasive disease have similar survival to patients who present initially with muscle invasive disease.

Currently, there are few markers that are available to predict which patients will progress to muscle invasive disease and need earlier, more aggressive intervention.

Time to definitive therapy has been shown to be critical in the survival of patients with invasive bladder cancer. This is important for patients with T1 bladder cancer because the risk of under-staging occurs in up to 30% of patients. While a re-staging transurethral resection can help identify those patients who have been under-staged, we performed the current study to determine other histologic features that may be associated with the risk of under-staging. Invasion of the muscularis mucosae (when present), urethral involvement, and divergent histology all increased the risk of under-staging, and the cumulative effect of having all three adverse features increased the odds of under-staging 20-fold.

While these features do not replace the need for a re-staging transurethral resection of the bladder, their presence on the initial biopsy may guide clinicians to recommend earlier more definitive therapy with T1 disease potentially reducing the timeline to proceed to more aggressive management such as radical cystectomy and urinary diversion.

Written by Alon Z. Weizer, MD as part of Beyond the Abstract on UroToday.com

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