SS  Vol.3 No.7 , July 2012
Clinicopathological Analysis of Patients with Nonmuscle-Invasive Bladder Cancer Who Underwent Radical Cystectomy
Abstract: Objectives: Surgical specimens obtained at the time of the last transurethral resection of bladder tumor (TURBT) for patients with nonmuscle-invasive bladder cancer (NMIBC) who underwent radical cystectomy were retrospectively evaluated in order to investigate the relationship between pathological variation and upstaging of NMIBC. Methods and Materials: Twenty patients (19 men, 1 woman; aged 69.4 ± 12.1 (mean ± SD) years) diagnosed with NMIBC underwent radical cystectomy during follow-up. Results: Five of the 20 patients (25%) had pathological upstaging in the radical cystectomy specimens. There was a statistical association between pathological upstaging and cancer death (p = 0.002). There were three patterns of pathological variation in the upstaged specimens: 1) in patients with BCG-resistant NMIBC, urothelial carcinoma invaded through the lamina propria; 2) urothelial carcinoma showed diffuse invasion beyond the deep lamina propria, and the cancer cells had infiltrated as single cells and formed nodules; 3) TURBT specimens showed a micropapillary variant. Conclusions: Since these pathological variations correlated with pathological upstaging, they may provide an indication for cystectomy in NMIBC patients.
Cite this paper: N. Nishiyama, H. Kitamura, M. Mutoh, M. Yanase, H. Iwaki, T. Hasegawa and T. Tsukamoto, "Clinicopathological Analysis of Patients with Nonmuscle-Invasive Bladder Cancer Who Underwent Radical Cystectomy," Surgical Science, Vol. 3 No. 7, 2012, pp. 347-352. doi: 10.4236/ss.2012.37068.

[1]   D. J. Parekh, B. H. Bochner and G. Dalbagni, “Superficial and Muscle-Invasive Bladder Cancer: Principles of Management for Outcomes Assessments,” Journal of Clinical Oncology, Vol. 24, No. 35, 2006, pp. 19-27. doi:10.1200/JCO.2006.08.5431

[2]   H. Kitamura and T. Tsukamoto, “Early Bladder Cancer: Concept, Diagnosis, and Management,” International Journal of Clinical Oncology, Vol. 11, No. 1, 2006, pp. 28-37. doi:10.1007/s10147-006-0552-y

[3]   E. Okajima, H. Fujimoto, Y. Mizutani, Y. Mizutani, E. Kikuchi, H. Koga, S. Hinotsu, N. Shinohara and T. Miki, “Cancer Death from Non-Muscle Invasive Bladder Cancer: Report of the Japanese Urological Association of Data from the 1999-2001 Registry in Japan,” International Journal of Urology, Vol. 17, No. 11, 2010, pp. 905-912. doi:10.1111/j.1442-2042.2010.02633.x

[4]   Lopez-Beltran, “Bladder Cancer: Clinical and Pathological Profile,” Scandinavian Journal of Urology and Nephrology, Vol. 42, No. 4, 2008, pp. 95-109.

[5]   K. Matsumoto, E. Kikuchi, Y. Horiguchi, N. Tanaka, A. Miyajima, K. Nakagawa, J. Nakashima and M. Oya, “Late Recurrence and Progression in Non-Muscle-Invasive Bladder Cancers after 5-Year Tumor-Free Periods,” Urology, Vol. 75, No. 6, 2010, pp. 1385-1390. doi:10.1016/j.urology.2009.09.088

[6]   H. M. Fritsche, M. Burger, R. S. Svatek, C. Jeldres, P. I. Karakiewicz, G. Novara, E. Skinner, S. Denzinger, Y. Fradet, H. Isbarn, P. J. Bastian, B. G. Volkmer, F. Montorsi, W. Kassouf, D. Tilki, W. Otto, U. Capitanio, J. I. Izawa, V. Ficarra, S. Lerner, A. I. Sagalowsky, M. Schoenberg, A. Kamat, C. P. Dinney, Y. Lotan and S. F. Shariat, “Characteristics and Outcomes of Patients with Clinical T1 Grade 3 Urothelial Carcinoma Treated with Radical Cystectomy: Results from an International Cohort,” European Uro

[7]   G. S. Kulkarni, O. W. Hakenberg, J. E. Gschwend, G. Thalmann, W. Kassouf, A. Kamat and A. Zlotta, “An Updated Critical Analysis of the Treatment Strategy for Newly Diagnosed High-Grade T1 (Previously T1G3) Bladder Cancer,” European Urology, Vol. 57, No. 1, 2010, pp. 60-70. doi:10.1016/j.eururo.2009.08.024

[8]   M. S. Soloway, M. Sofer and A. Vaidya, “Contemporary Management of Stage T1 Transitional Cell Carcinoma of the Bladder,” Journal of Urology, Vol. 167, No. 4, 2002, pp. 1573-1583. doi:10.1016/S0022-5347(05)65157-9

[9]   H. W. Herr and P. C. Sogani, “Does Early Cystectomy Improve the Survival of Patients with High Risk Superficial Bladder Tumors?” Journal of Urology, Vol. 166, No. 4, 2001, pp. 1296-1299. doi:10.1016/S0022-5347(05)65756-4

[10]   T. J. Guzzo, A. Magheli, T. J. Bivalacqua, M. E. Nielsen, F. J. Attenello, M. P. Schoenberg and M. L. Gonzalgo, “Pathological Upstaging during Radical Cystectomy Is Associated with Worse Recurrence-Free Survival in Patients with Bacillus Calmette-Guerin-Refractory Bladder Cancer,” Urology, Vol. 74, No. 6, 2009, pp. 1276-1280. doi:10.1016/j.urology.2009.05.092

[11]   M. Brake, H. Loertzer, R. Horsch and H. Keller, “Recurrence and Progression of Stage T1, Grade 3 Transitional Cell Carcinoma of the Bladder Following Intravesical Immunotherapy with Bacillus Calmette-Guerin,” Journal of Urology, Vol. 163, No. 6, 2000, pp. 1697-1701. doi:10.1016/S0022-5347(05)67523-4

[12]   L. Cheng, A. L. Weaver, R. M. Neumann, B. G. Scherer and D. G. Bostwick, “Substaging of T1 Bladder Carcinoma Based on the Depth of Invasion as Measured by Micrometer: A New Proposal,” Cancer, Vol. 86, No. 6, 1999, pp. 1035-1043. doi:10.1002/(SICI)1097-0142(19990915)86:6<1035::AID-CNCR20>3.0.CO;2-D

[13]   L. Cheng, R. M. Neumann, A. L. Weaver, B. E. Spotts and D. G. Bostwick, “Predicting Cancer Progression in Patients with Stage T1 Bladder Carcinoma,” Journal of Clinical Oncology, Vol. 17, No. 10, 1999, pp. 3182-3187.

[14]   R. Montironi, R. Mazzucchelli, M. Scarpelli, A. Lopez-Beltran and L. Cheng, “Morphological Diagnosis of Urothelial Neoplasms,” Journal of Clinical Pathology, Vol. 61, No. 1, 2008, pp. 3-10. doi:10.1136/jcp.2007.049312

[15]   M. Younes, J. Sussman and L. D. True, “The Usefulness of the Level of the Muscularis Mucosae in the Staging of Invasive Transitional Cell Carcinoma of the Urinary Bladder,” Cancer, Vol. 66, No. 3, 1990, pp. 543-548. doi:10.1002/1097-0142(19900801)66:3<543::AID-CNCR2820660323>3.0.CO;2-R

[16]   J. C. Angulo, J. I. Lopez, D. J. Grignon and M. Sanchez-Chapado, “Muscularis Mucosa Differentiates two Populations with Different Prognosis in Stage T1 Bladder Cancer,” Urology, Vol. 45, No. 1, 1995, pp. 47-53. doi:10.1016/S0090-4295(95)96490-8

[17]   S. Holmang, H. Hedelin, C. Anderstrom, E. Holmberg and S. L. Johansson, “The Importance of the Depth of Invasion in Stage T1 Bladder Carcinoma: A Prospective Cohort Study,” Journal of Urology, Vol. 157, No. 3, 1997, pp. 800-803. doi:10.1016/S0022-5347(01)65044-4

[18]   G. G. Hermann, T. Horn and K. Steven, “The Influence of the Level of Lamina Propria Invasion and the Prevalence of p53 Nuclear Accumulation on Survival in Stage T1 Transitional Cell Bladder Cancer,” Journal of Urology, Vol. 159, No. 1, 1998, pp. 91-94. doi:10.1016/S0022-5347(01)64021-7

[19]   R. E. Jimenez, E. Gheiler, P. Oskanian, R. Tiguert, W. Sakr, D. P. Wood Jr., J. E. Pontes and D. J. Grignon, “Grading the Invasive Component of Urothelial Carcinoma of the Bladder and Its Relationship with Progression-Free Survival,” The American Journal of Surgical Pathology, Vol. 24, No. 7, 2000, pp. 980-987. doi:10.1097/00000478-200007000-00009

[20]   N. Edgerton, S. J. Sirintrapun, M. Munoz, Z. Chen and A. O. Osunkoya, “Micropapillary Urothelial Carcinoma of the Urinary Bladder: A Clinicopathological Analysis of 24 Cases,” International Journal of Urology, Vol. 18, No. 1, 2011, pp. 49-54. doi:10.1111/j.1442-2042.2010.02672.x

[21]   M. Kamat, J. R. Gee, C. P. Dinney, H. B. Grossman, D. A. Swanson, R. E. Millikan, M. A. Detry, T. L. Robinson and L. L. Pisters, “The Case for Early Cystectomy in the Treatment of Nonmuscle Invasive Micropapillary Bladder Carcinoma,” Journal of Urology, Vol. 175, No. 3, 2006, pp. 881-885. doi:10.1016/S0022-5347(05)00423-4

[22]   M. Kamat, C. P. Dinney, J. R. Gee, H. B. Grossman, A. O. Siefker-Radtke, P. Tamboli, M. A. Detry, T. L. Robinson and L. L. Pisters, “Micropapillary Bladder Cancer: A Review of the University of Texas M.D. Anderson Cancer Center Experience with 100 Consecutive Patients,” Cancer, Vol. 110, No. 1, 2007, pp. 62-67. doi:10.1002/cncr.22756