Oncological, pathological and clinical reflections of submucosals invasion depth of T1 bladder tumors

Bladder cancer is the seventh most common disease in men and the tenth when both sexes are considered together, worldwide, and most cases are limited to the mucosa or submucosa. The prognostic significance of lamina propria invasion depth and extent in T1 bladder cancer is increasingly being investigated, and the present study aimed to compare the effects of T1a/b/c and T1e/m substaging systems on survival and progression. Material-Method This retrospective study, approved by the Çukurova University Faculty of Medicine Research Ethics Committee at its meeting dated 06.09.2024 and numbered 147, with decision numbered 74, was conducted by re-examining the pathology preparations of 103 patients who underwent TUR-M due to bladder mass between 2010-2019 and whose pathology showed positive submucosal invasion. T1 tumors were sub-staged with two different systems based on T1a/b/c and T1m/e subgrouping; histological features of the tumor, presence of CIS and other clinical parameters were examined. The effects of subgroups on prognosis and survival were compared. Results In this study, demographic, clinical and pathological features of 103 T1 bladder cancer patients were retrospectively examined and the prognostic importance of T1a/b/c and T1m/e sub-staging systems was evaluated. The recurrence rate was determined as 76.0% in the T1c group, 46.7% in the T1a group and 61.1% in the T1b group, and the high recurrence rate in the T1c group was found to be statistically significant (p=0.041). Likewise, a high recurrence rate in the T1e group was found to be statistically significant (p=0.031). When the recurrence-free survival times were evaluated, the average was 84.5 months in the T1a group and 27.3 months in the T1c group, and this difference was found to be significant (p=0.032). Progression-free survival analysis revealed that the T1c group had a higher risk of progression compared to the T1a group (p=0.037). Progression-free survival analysis was found to be statistically significantly longer in the T1m group compared to the T1e group (p=0.037). Similarly, recurrence-free survival time was also found to be significantly longer in the T1m group compared to the T1e group (p=0.043). Variant histology has been shown to have a negative effect on cancer-specific survival, and this difference was found to be significant (p<0.001). According to Harrell's C analysis, T1a-c and T1m/e classification systems had similar predictive values, with p values of 0.534 and 0.523 for recurrence-free survival and progression-free survival, respectively. Conclusion This study evaluated the prognostic significance of two different sub-staging systems (T1a-c and T1m-e) in T1 bladder cancer and compared their effectiveness in predicting recurrence and progression. The findings showed that patients in the T1c and T1e subgroups have a higher risk of progression and may require more aggressive treatment protocols. The study reveals that current classification systems should be supported with new parameters and that these systems can make significant contributions to patient management. Keywords: Bladder Cancer, T1 substaging, Recurrence, Progression, Risk Classification