Editing Non-Muscle Invasive Bladder Cancer (section)

=== Progression ===
* '''<span style="color:#ff0000">Progression rates (defined by higher grade or stage): ≈20-30%</span>'''
* '''<span style="color:#ff0000">Risk factors (3):[https://pubmed.ncbi.nlm.nih.gov/33938798/ $$]</span>'''
*# '''<span style="color:#ff0000">Grade (most important)</span>'''
*#* '''<span style="color:#ff0000">Grade more important than stage (unlike other cancers where stage is more important)</span>'''
*#** '''<span style="color:#ff0000">High-grade tumors progress with similar frequency regardless of whether they are invasive (T1) or non-invasive (Ta)</span>'''
*#** '''<span style="color:#ff0000">Stage Ta are usually LG; however, ≈7% of Ta disease is HG</span>'''
*# '''<span style="color:#ff0000">Stage (second most important)</span>'''
*#* '''<span style="color:#ff0000">TaLG: high recurrence rate (≈55%), but much lower stage progression rate ≈6%</span>'''
*#* '''<span style="color:#ff0000">T1HG: high recurrence rate (≈45%) and high progression rate ≈17% [different numbers than Chapter 93]</span>'''
*# '''<span style="color:#ff0000">CIS</span>'''
*#* If CIS is treated only with TURBT,
*#** High risk of recurrence (as high as 90%)
*#** High risk (> 50%) for progressing to muscle-invasive disease.
*#* Even patients with a complete response to intravesical BCG will experience progression in 30% to 40% of cases on longitudinal follow-up
*#* Concomitant CIS is associated with significantly increased risk of disease progression and disease-specific mortality
'''<span style="color:#ff0000">Other risk factors</span>'''
* '''Mentioned in [https://pubmed.ncbi.nlm.nih.gov/33938798/ 2021 CUA NMIBC Guidelines] (5):'''
*# '''<span style="color:#ff0000">Age > 70 yr</span>'''
*# '''<span style="color:#ff0000">Extensive invasion of the lamina propria</span>'''
*#* Extent of invasion of T1 tumours has been evaluated using two different criteria:
*## Micrometric: evaluates the millimetric extent of invasion into the lamina propria
*## Microanatomic: evaluates the level of invasion in relation to the muscularis mucosa (T1a – no muscularis mucosa invasion, T1b – invasion at the level of the muscularis mucosa and T1c – invasion beyond the muscularis mucosa)
*#*No single approach has been universally adopted
*# '''<span style="color:#ff0000">Lymphovascular invasion (LVI)</span>'''
*#* '''Retrospective studies demonstrate that the presence of LVI is an independent factor for progression in patients with high-risk NMIBC'''.
*#** '''Use of LVI as a prognostic variable on transurethral resection (TUR) specimen requires prospective validation'''
*#* In NIMBC, LVI is associated with increased risk of recurrence and progression in BCG-treated patients with T1 NMIBC[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4719750/ §]
*# '''<span style="color:#ff0000">Aggressive histological variants such as (3): micropapillary, plasmacytoid, and sarcomatoid</span>'''
*#* See Bladder Cancer: Pathology & TNM Staging
*#* '''<span style="color:#ff0000">Associated with under-staging and early progression to muscle invasive disease</span>'''
*# '''<span style="color:#ff0000">First assessment after TURBT</span>'''
*#* Persistent disease at the first surveillance cystoscopy after induction intravesical treatment has been shown to be a risk factor associated with progression
* '''Mentioned in Campbell’s'''
** '''Tumour architecture: papillary vs. sessile'''
** '''Status of the remaining urothelium'''