Non-Muscle Invasive Bladder Cancer: Difference between revisions
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== Prognosis of NMIBC == | == Prognosis of NMIBC == | ||
=== Recurrence === | |||
* '''<span style="color:#ff0000">Recurrence rate: ≈60-70%</span>''' | * '''<span style="color:#ff0000">Recurrence rate: ≈60-70%</span>''' | ||
* | * <span style="color:#ff0000">'''Risk factors (3):[https://pubmed.ncbi.nlm.nih.gov/33938798/ $$]'''</span> | ||
* | *# <span style="color:#ff0000">'''Prior recurrence rate''' (>1 year)</span> | ||
* | *# <span style="color:#ff0000">'''Number of tumours'''</span> | ||
*#* '''<span style="color:#ff0000">Grade more important than stage | *# <span style="color:#ff0000">'''Tumour size (>3 cm)'''</span> | ||
*#** '''High-grade tumors progress with similar frequency regardless of whether they are invasive (T1) or non-invasive (Ta)''' | |||
*#** '''Stage Ta are usually LG; however, ≈7% of Ta disease is HG''' | === Progression === | ||
*# ''' | * '''<span style="color:#ff0000">Progression rates (defined by higher grade or stage): ≈20-30%</span>''' | ||
*#* TaLG: high recurrence rate (≈55%), but much lower stage | * '''<span style="color:#ff0000">Risk factors (3):[https://pubmed.ncbi.nlm.nih.gov/33938798/ $$]</span>''' | ||
*#* T1HG: high recurrence rate (≈45%) and high progression rate ≈17% [different numbers than Chapter 93] | *# '''<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, | *#* If CIS is treated only with TURBT, | ||
*#** High risk of recurrence (as high as 90%) | *#** High risk of recurrence (as high as 90%) | ||
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*#* Even patients with a complete response to intravesical BCG will experience progression in 30% to 40% of cases on longitudinal follow-up | *#* 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 | *#* 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''' | |||
=== Estimating Prognosis === | |||
*[http://www.eortc.be/tools/bladdercalculator/ European Organization for Research and Treatment of Cancer (EORTC) Risk Tables] | |||
**Provides individualized probability of recurrence and progression of NMIBC | |||
**Developed from individual patient data from 2596 patients diagnosed with Ta/T1 tumours who were randomized in 7 EORTC trials. | |||
**Estimates based on can be calculated based on (6): | |||
**# Number of tumors | |||
**# Tumor size | |||
**# Prior recurrence rate | |||
**# T category | |||
**# Concomitant carcinoma in situ | |||
**# Grade | |||
** Note that the EORTC risk calculator likely overestimates the risk of recurrence and progression, as very few of the patients in these prospective trials received intravesical BCG | |||
== Genetics of NMIBC == | == Genetics of NMIBC == | ||