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AJCC Staging of Bladder Cancers

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Urinary Bladder Pathology
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Abstract

Treatment decisions and prognostic expectations for bladder cancer rely on accurate pathologic staging. Pathologic staging of bladder cancers is performed on tissue obtained after radical cystectomy and utilizes the American Joint Committee on Cancer (AJCC) staging system. The eighth edition of the AJCC staging manual has been published and implemented in January 2018 to update staging criteria for bladder cancer, with several critical changes and clarifications. This chapter will discuss the AJCC eighth edition with emphasis on the selected changes and/or clarifications. Diagnostic pitfalls and controversial issues in staging and substaging of bladder cancer will be also discussed.

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References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34. https://doi.org/10.3322/caac.21551.

    Article  PubMed  Google Scholar 

  2. Alfred Witjes J, Lebret T, Comperat EM, Cowan NC, De Santis M, Bruins HM, Hernandez V, Espinos EL, Dunn J, Rouanne M, Neuzillet Y, Veskimae E, van der Heijden AG, Gakis G, Ribal MJ. Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder Cancer. Eur Urol. 2017;71(3):462–75. https://doi.org/10.1016/j.eururo.2016.06.020.

    Article  CAS  PubMed  Google Scholar 

  3. Babjuk M, Bohle A, Burger M, Capoun O, Cohen D, Comperat EM, Hernandez V, Kaasinen E, Palou J, Roupret M, van Rhijn BW, Shariat SF, Soukup V, Sylvester RJ, Zigeuner R. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol. 2017;71(3):447–61. https://doi.org/10.1016/j.eururo.2016.05.041.

    Article  PubMed  Google Scholar 

  4. Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, Lotan Y, Meeks JJ, Michalski JM, Morgan TM, Quale DZ, Rosenberg JE, Zietman AL, Holzbeierlein JM. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline. J Urol. 2017;198(3):552–9. https://doi.org/10.1016/j.juro.2017.04.086.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chang SS, Boorjian SA, Chou R, Clark PE, Daneshmand S, Konety BR, Pruthi R, Quale DZ, Ritch CR, Seigne JD, Skinner EC, Smith ND, McKiernan JM. Diagnosis and treatment of non-muscle invasive bladder Cancer: AUA/SUO guideline. J Urol. 2016;196(4):1021–9. https://doi.org/10.1016/j.juro.2016.06.049.

    Article  PubMed  Google Scholar 

  6. Gallan AJ, Choy B, Paner GP. Contemporary grading and staging of urothelial neoplasms of the urinary bladder: new concepts and approaches to challenging scenarios. Surg Pathol Clin. 2018;11(4):775–95. https://doi.org/10.1016/j.path.2018.07.006.

    Article  PubMed  Google Scholar 

  7. Brierley JGM, Wittekind C. TNM classification of malignant tumours. 8th ed. Chichester: John Wiley & Sons Inc; 2017.

    Google Scholar 

  8. Delahunt B, Egevad L, Samaratunga H, Varma M, Verrill C, Cheville J, Kristiansen G, Corbishley C, Berney DM. UICC drops the ball in the 8th edition TNM staging of urological cancers. Histopathology. 2017;71(1):5–11. https://doi.org/10.1111/his.13200.

    Article  PubMed  Google Scholar 

  9. Amin MBES, Greene FL, et al. AJCC cancer staging manual. 8th ed. Chicago: Springer; 2016.

    Google Scholar 

  10. Dalbagni G, Genega E, Hashibe M, Zhang ZF, Russo P, Herr H, Reuter V. Cystectomy for bladder cancer: a contemporary series. J Urol. 2001;165(4):1111–6.

    Article  CAS  PubMed  Google Scholar 

  11. Kassouf W, Spiess PE, Brown GA, Munsell MF, Grossman HB, Siefker-Radtke A, Dinney CP, Kamat AM. P0 stage at radical cystectomy for bladder cancer is associated with improved outcome independent of traditional clinical risk factors. Eur Urol. 2007;52(3):769–74. https://doi.org/10.1016/j.eururo.2007.03.086.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Palapattu GS, Shariat SF, Karakiewicz PI, Bastian PJ, Rogers CG, Amiel G, Lotan Y, Vazina A, Gupta A, Sagalowsky AI, Lerner SP, Schoenberg MP. Cancer specific outcomes in patients with pT0 disease following radical cystectomy. J Urol. 2006;175(5):1645–9.; discussion 1649. https://doi.org/10.1016/s0022-5347(05)00995-x.

    Article  PubMed  Google Scholar 

  13. Thrasher JB, Frazier HA, Robertson JE, Paulson DF. Does of stage pT0 cystectomy specimen confer a survival advantage in patients with minimally invasive bladder cancer? J Urol. 1994;152(2 Pt 1):393–6. https://doi.org/10.1016/s0022-5347(17)32746-5.

    Article  CAS  PubMed  Google Scholar 

  14. Volkmer BG, Kuefer R, Bartsch G Jr, Straub M, de Petriconi R, Gschwend JE, Hautmann RE. Effect of a pT0 cystectomy specimen without neoadjuvant therapy on survival. Cancer. 2005;104(11):2384–91. https://doi.org/10.1002/cncr.21475.

    Article  PubMed  Google Scholar 

  15. Yiou R, Patard JJ, Benhard H, Abbou CC, Chopin DK. Outcome of radical cystectomy for bladder cancer according to the disease type at presentation. BJU Int. 2002;89(4):374–8. https://doi.org/10.1046/j.1464-4096.2001.001020.x.

    Article  CAS  PubMed  Google Scholar 

  16. Kim HS, Jeong CW, Kwak C, Kim HH, Ku JH. Pathological T0 following cisplatin-based neoadjuvant chemotherapy for muscle-invasive bladder cancer: a network meta-analysis. Clin Cancer Res. 2016;22(5):1086–94. https://doi.org/10.1158/1078-0432.Ccr-15-1208.

    Article  CAS  PubMed  Google Scholar 

  17. Lavery HJ, Stensland KD, Niegisch G, Albers P, Droller MJ. Pathological T0 following radical cystectomy with or without neoadjuvant chemotherapy: a useful surrogate. J Urol. 2014;191(4):898–906. https://doi.org/10.1016/j.juro.2013.10.142.

    Article  PubMed  Google Scholar 

  18. Petrelli F, Coinu A, Cabiddu M, Ghilardi M, Vavassori I, Barni S. Correlation of pathologic complete response with survival after neoadjuvant chemotherapy in bladder cancer treated with cystectomy: a meta-analysis. Eur Urol. 2014;65(2):350–7. https://doi.org/10.1016/j.eururo.2013.06.049.

    Article  PubMed  Google Scholar 

  19. Pokuri VK, Syed JR, Yang Z, Field EP, Cyriac S, Pili R, Levine EG, Azabdaftari G, Trump DL, Guru K, George S. Predictors of complete pathologic response (pT0) to neoadjuvant chemotherapy in muscle-invasive bladder carcinoma. Clin Genitourin Cancer. 2016;14(1):e59–65. https://doi.org/10.1016/j.clgc.2015.09.013.

    Article  PubMed  Google Scholar 

  20. Shariat SF, Karakiewicz PI, Palapattu GS, Lotan Y, Rogers CG, Amiel GE, Vazina A, Gupta A, Bastian PJ, Sagalowsky AI, Schoenberg MP, Lerner SP. Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the bladder Cancer research consortium. J Urol. 2006;176(6 Pt 1):2414–22.; discussion 2422. https://doi.org/10.1016/j.juro.2006.08.004.

    Article  PubMed  Google Scholar 

  21. Paner GP, Ro JY, Wojcik EM, Venkataraman G, Datta MW, Amin MB. Further characterization of the muscle layers and lamina propria of the urinary bladder by systematic histologic mapping: implications for pathologic staging of invasive urothelial carcinoma. Am J Surg Pathol. 2007;31(9):1420–9. https://doi.org/10.1097/PAS.0b013e3180588283.

    Article  PubMed  Google Scholar 

  22. Brimo F, Wu C, Zeizafoun N, Tanguay S, Aprikian A, Mansure JJ, Kassouf W. Prognostic factors in T1 bladder urothelial carcinoma: the value of recording millimetric depth of invasion, diameter of invasive carcinoma, and muscularis mucosa invasion. Hum Pathol. 2013;44(1):95–102. https://doi.org/10.1016/j.humpath.2012.04.020.

    Article  PubMed  Google Scholar 

  23. Cheng L, Neumann RM, Weaver AL, Spotts BE, Bostwick DG. Predicting cancer progression in patients with stage T1 bladder carcinoma. J Clin Oncol Off J Am Soc Clin Oncol. 1999;17(10):3182–7. https://doi.org/10.1200/jco.1999.17.10.3182.

    Article  CAS  Google Scholar 

  24. Dixon JS, Gosling JA. Histology and fine structure of the muscularis mucosae of the human urinary bladder. J Anat. 1983;136(Pt 2):265–71.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Ro JY, Ayala AG, el-Naggar A (1987) Muscularis mucosa of urinary bladder. Importance for staging and treatment. Am J Surg Pathol 11(9):668–673. https://doi.org/10.1097/00000478-198709000-00002.

  26. Philip AT, Amin MB, Tamboli P, Lee TJ, Hill CE, Ro JY. Intravesical adipose tissue: a quantitative study of its presence and location with implications for therapy and prognosis. Am J Surg Pathol. 2000;24(9):1286–90. https://doi.org/10.1097/00000478-200009000-00013.

    Article  CAS  PubMed  Google Scholar 

  27. Orsola A, Werner L, de Torres I, Martin-Doyle W, Raventos CX, Lozano F, Mullane SA, Leow JJ, Barletta JA, Bellmunt J, Morote J. Reexamining treatment of high-grade T1 bladder cancer according to depth of lamina propria invasion: a prospective trial of 200 patients. Br J Cancer. 2015;112(3):468–74. https://doi.org/10.1038/bjc.2014.633.

    Article  CAS  PubMed  Google Scholar 

  28. Paner GP, Montironi R, Amin MB. Challenges in pathologic staging of bladder cancer: proposals for fresh approaches of assessing pathologic stage in light of recent studies and observations pertaining to bladder Histoanatomic variances. Adv Anat Pathol. 2017;24(3):113–27. https://doi.org/10.1097/pap.0000000000000152.

    Article  PubMed  Google Scholar 

  29. Patriarca C, Hurle R, Moschini M, Freschi M, Colombo P, Colecchia M, Ferrari L, Guazzoni G, Conti A, Conti G, Luciano R, Magnani T, Colombo R. Usefulness of pT1 substaging in papillary urothelial bladder carcinoma. Diagn Pathol. 2016;11:6. https://doi.org/10.1186/s13000-016-0466-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Roupret M, Seisen T, Comperat E, Larre S, Mazerolles C, Gobet F, Fetissof F, Fromont G, Safsaf A, d’Arcier BF, Celhay O, Validire P, Rozet F, Irani J, Soulie M, Pfister C. Prognostic interest in discriminating muscularis mucosa invasion (T1a vs T1b) in nonmuscle invasive bladder carcinoma: French national multicenter study with central pathology review. J Urol. 2013;189(6):2069–76. https://doi.org/10.1016/j.juro.2012.11.120.

    Article  PubMed  Google Scholar 

  31. Andius P, Johansson SL, Holmang S. Prognostic factors in stage T1 bladder cancer: tumor pattern (solid or papillary) and vascular invasion more important than depth of invasion. Urology. 2007;70(4):758–62. https://doi.org/10.1016/j.urology.2007.06.638.

    Article  PubMed  Google Scholar 

  32. Angulo JC, Lopez JI, Grignon DJ, Sanchez-Chapado M. Muscularis mucosa differentiates two populations with different prognosis in stage T1 bladder cancer. Urology. 1995;45(1):47–53. https://doi.org/10.1016/s0090-4295(95)96490-8.

    Article  CAS  PubMed  Google Scholar 

  33. Bernardini S, Billerey C, Martin M, Adessi GL, Wallerand H, Bittard H. The predictive value of muscularis mucosae invasion and p53 over expression on progression of stage T1 bladder carcinoma. J Urol. 2001;165(1):42–6.; discussion 46. https://doi.org/10.1097/00005392-200101000-00011.

    Article  CAS  PubMed  Google Scholar 

  34. Bertz S, Denzinger S, Otto W, Wieland WF, Stoehr R, Hofstaedter F, Hartmann A. Substaging by estimating the size of invasive tumour can improve risk stratification in pT1 urothelial bladder cancer-evaluation of a large hospital-based single-Centre series. Histopathology. 2011;59(4):722–32. https://doi.org/10.1111/j.1365-2559.2011.03989.x.

    Article  PubMed  Google Scholar 

  35. Chang WC, Chang YH, Pan CC. Prognostic significance in substaging of T1 urinary bladder urothelial carcinoma on transurethral resection. Am J Surg Pathol. 2012;36(3):454–61. https://doi.org/10.1097/PAS.0b013e31823dafd3.

    Article  PubMed  Google Scholar 

  36. Faivre d’Arcier B, Celhay O, Safsaf A, Zairi A, Pfister C, Soulie M, Rozet F, Roupret M, Fromont G, Mazerolles C, Gobet F, Fetissof F, Irani J. T1 bladder carcinoma: prognostic value of the muscularis mucosae invasion (T1a/T1b). A multicenter study by the French urological association (CCAFU). Prog Urol. 2010;20(6):440–9. https://doi.org/10.1016/j.purol.2010.02.002.

    Article  PubMed  Google Scholar 

  37. Fransen van de Putte EE, Behrendt MA, Pigot GL, van der Kwast TH, van Rhijn BW. Prognostic significance of substage and WHO classification systems in T1 urothelial carcinoma of the bladder. Curr Opin Urol. 2015;25(5):427–35. https://doi.org/10.1097/mou.0000000000000202.

    Article  PubMed  Google Scholar 

  38. Hasui Y, Osada Y, Kitada S, Nishi S. Significance of invasion to the muscularis mucosae on the progression of superficial bladder cancer. Urology. 1994;43(6):782–6. https://doi.org/10.1016/0090-4295(94)90134-1.

    Article  CAS  PubMed  Google Scholar 

  39. Hermann GG, Horn T, Steven K. 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. J Urol. 1998;159(1):91–4. https://doi.org/10.1016/s0022-5347(01)64021-7.

    Article  CAS  PubMed  Google Scholar 

  40. Holmang S, Hedelin H, Anderstrom C, Holmberg E, Johansson SL. The importance of the depth of invasion in stage T1 bladder carcinoma: a prospective cohort study. J Urol. 1997;157(3):800–3.; discussion 804. https://doi.org/10.1016/s0022-5347(01)65044-4.

    Article  CAS  PubMed  Google Scholar 

  41. Kondylis FI, Demirci S, Ladaga L, Kolm P, Schellhammer PF. Outcomes after intravesical bacillus Calmette-Guerin are not affected by substaging of high grade T1 transitional cell carcinoma. J Urol. 2000;163(4):1120–3.

    Article  CAS  PubMed  Google Scholar 

  42. Lee JY, Joo HJ, Cho DS, Kim SI, Ahn HS, Kim SJ. Prognostic significance of substaging according to the depth of Lamina Propria invasion in primary T1 transitional cell carcinoma of the bladder. Korean J Urol. 2012;53(5):317–23. https://doi.org/10.4111/kju.2012.53.5.317.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Mhawech-Fauceglia P, Fischer G, Alvarez V Jr, Ahmed A, Herrmann FR. Predicting outcome in minimally invasive (T1a and T1b) urothelial bladder carcinoma using a panel of biomarkers: a high throughput tissue microarray analysis. BJU Int. 2007;100(5):1182–7. https://doi.org/10.1111/j.1464-410X.2007.07090.x.

    Article  PubMed  Google Scholar 

  44. Nguyen-Huu Y, Delorme G, Lillaz J, Bedgedjian I, Le Ray-Ferrieres I, Chabannes E, Bernardini S, Guichard G, Bittard H, Kleinclauss F. Muscularis mucosae invasion: prognostic factor for intravesical BCG immunotherapy failure for T1 bladder carcinoma. Prog Urol. 2012;22(5):284–90. https://doi.org/10.1016/j.purol.2011.10.002.

    Article  CAS  PubMed  Google Scholar 

  45. Olsson H, Hultman P, Rosell J, Jahnson S. Population-based study on prognostic factors for recurrence and progression in primary stage T1 bladder tumours. Scand J Urol. 2013;47(3):188–95. https://doi.org/10.3109/00365599.2012.719539.

    Article  PubMed  Google Scholar 

  46. Orsola A, Cecchini L, Raventos CX, Trilla E, Planas J, Landolfi S, de Torres I, Morote J. Risk factors for positive findings in patients with high-grade T1 bladder cancer treated with transurethral resection of bladder tumour (TUR) and bacille Calmette-Guerin therapy and the decision for a repeat TUR. BJU Int. 2010;105(2):202–7. https://doi.org/10.1111/j.1464-410X.2009.08694.x.

    Article  PubMed  Google Scholar 

  47. Orsola A, Trias I, Raventos CX, Espanol I, Cecchini L, Bucar S, Salinas D, Orsola I. Initial high-grade T1 urothelial cell carcinoma: feasibility and prognostic significance of lamina propria invasion microstaging (T1a/b/c) in BCG-treated and BCG-non-treated patients. Eur Urol. 2005;48(2):231–8.; discussion 238. https://doi.org/10.1016/j.eururo.2005.04.013.

    Article  CAS  PubMed  Google Scholar 

  48. Palou J, Sylvester RJ, Faba OR, Parada R, Pena JA, Algaba F, Villavicencio H. Female gender and carcinoma in situ in the prostatic urethra are prognostic factors for recurrence, progression, and disease-specific mortality in T1G3 bladder cancer patients treated with bacillus Calmette-Guerin. Eur Urol. 2012;62(1):118–25. https://doi.org/10.1016/j.eururo.2011.10.029.

    Article  PubMed  Google Scholar 

  49. Patschan O, Sjodahl G, Chebil G, Lovgren K, Lauss M, Gudjonsson S, Kollberg P, Eriksson P, Aine M, Mansson W, Ferno M, Liedberg F, Hoglund M. A molecular pathologic framework for risk stratification of stage T1 urothelial carcinoma. Eur Urol. 2015;68(5):824–32.; discussion 835-826. https://doi.org/10.1016/j.eururo.2015.02.021.

    Article  CAS  PubMed  Google Scholar 

  50. Platz CE, Cohen MB, Jones MP, Olson DB, Lynch CF. Is microstaging of early invasive cancer of the urinary bladder possible or useful? Modern pathology: an official journal of the United States and canadian academy of pathology. Inc. 1996;9(11):1035–9.

    CAS  Google Scholar 

  51. Shariat SF, Weizer AZ, Green A, Laucirica R, Frolov A, Wheeler TM, Lerner SP. Prognostic value of P53 nuclear accumulation and histopathologic features in T1 transitional cell carcinoma of the urinary bladder. Urology. 2000;56(5):735–40. https://doi.org/10.1016/s0090-4295(00)00756-1.

    Article  CAS  PubMed  Google Scholar 

  52. Smits G, Schaafsma E, Kiemeney L, Caris C, Debruyne F, Witjes JA. Microstaging of pT1 transitional cell carcinoma of the bladder: identification of subgroups with distinct risks of progression. Urology. 1998;52(6):1009–13.; discussion 1013-1004. https://doi.org/10.1016/s0090-4295(98)00374-4.

    Article  CAS  PubMed  Google Scholar 

  53. Soukup V, Duskova J, Pesl M, Capoun O, Feherova Z, Zamecnik L, Hanus T, Babjuk M. The prognostic value of T1 bladder cancer substaging: a single institution retrospective study. Urol Int. 2014;92(2):150–6. https://doi.org/10.1159/000355358.

    Article  CAS  PubMed  Google Scholar 

  54. Sozen S, Akbal C, Sokmensuer C, Ekici S, Ozen H. Microstaging of pT1 transitional cell carcinoma of the bladder. Does it really differentiate two populations with different prognoses? (pT1 subcategory). Urol Int. 2002;69(3):200–6. https://doi.org/10.1159/000063941.

    Article  PubMed  Google Scholar 

  55. De Marco V, Cerruto MA, D’Elia C, Brunelli M, Otte O, Minja A, Luchini C, Novella G, Cavalleri S, Martignoni G, Artibani W. Prognostic role of substaging in T1G3 transitional cell carcinoma of the urinary bladder. Mol Clin Oncol. 2014;2(4):575–80. https://doi.org/10.3892/mco.2014.290.

    Article  Google Scholar 

  56. van Rhijn BW, van der Kwast TH, Alkhateeb SS, Fleshner NE, van Leenders GJ, Bostrom PJ, van der Aa MN, Kakiashvili DM, Bangma CH, Jewett MA, Zlotta AR. A new and highly prognostic system to discern T1 bladder cancer substage. Eur Urol. 2012;61(2):378–84. https://doi.org/10.1016/j.eururo.2011.10.026.

    Article  PubMed  Google Scholar 

  57. Cheng L, Weaver AL, Bostwick DG. Predicting extravesical extension of bladder carcinoma: a novel method based on micrometer measurement of the depth of invasion in transurethral resection specimens. Urology. 2000;55(5):668–72. https://doi.org/10.1016/s0090-4295(99)00595-6.

    Article  CAS  PubMed  Google Scholar 

  58. Cheng L, Weaver AL, Neumann RM, Scherer BG, Bostwick DG. Substaging of T1 bladder carcinoma based on the depth of invasion as measured by micrometer: a new proposal. Cancer. 1999;86(6):1035–43. https://doi.org/10.1002/(sici)1097-0142(19990915)86:6<1035::aid-cncr20>3.0.co;2-d.

    Article  CAS  PubMed  Google Scholar 

  59. van der Aa MN, van Leenders GJ, Steyerberg EW, van Rhijn BW, Jobsis AC, Zwarthoff EC, van der Kwast TH. A new system for substaging pT1 papillary bladder cancer: a prognostic evaluation. Hum Pathol. 2005;36(9):981–6. https://doi.org/10.1016/j.humpath.2005.06.017.

    Article  CAS  PubMed  Google Scholar 

  60. Hu Z, Mudaliar K, Quek ML, Paner GP, Barkan GA. Measuring the dimension of invasive component in pT1 urothelial carcinoma in transurethral resection specimens can predict time to recurrence. Ann Diagn Pathol. 2014;18(2):49–52. https://doi.org/10.1016/j.anndiagpath.2013.11.002.

    Article  PubMed  Google Scholar 

  61. Leivo MZ, Sahoo D, Hamilton Z, Mirsadraei L, Shabaik A, Parsons JK, Kader AK, Derweesh I, Kane C, Hansel DE. Analysis of T1 bladder cancer on biopsy and transurethral resection specimens: comparison and ranking of T1 quantification approaches to predict progression to Muscularis Propria invasion. Am J Surg Pathol. 2018;42(1):e1–e10. https://doi.org/10.1097/pas.0000000000000964.

    Article  PubMed  Google Scholar 

  62. Farrow GM, Utz DC, Rife CC. Morphological and clinical observations of patients with early bladder cancer treated with total cystectomy. Cancer Res. 1976;36(7 pt 2):2495–501.

    CAS  PubMed  Google Scholar 

  63. Lopez-Beltran A, Cheng L, Andersson L, Brausi M, de Matteis A, Montironi R, Sesterhenn I, van det Kwast KT, Mazerolles C. Preneoplastic non-papillary lesions and conditions of the urinary bladder: an update based on the Ancona international consultation. Virchows Arch. 2002;440(1):3–11. https://doi.org/10.1007/s00428-001-0577-6.

    Article  PubMed  Google Scholar 

  64. Lawless M, Gulati R, Tretiakova M. Stalk versus base invasion in pT1 papillary cancers of the bladder: improved substaging system predicting the risk of progression. Histopathology. 2017;71(3):406–14. https://doi.org/10.1111/his.13247.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Lopez-Beltran A, Cheng L. Stage pT1 bladder carcinoma: diagnostic criteria, pitfalls and prognostic significance. Pathology. 2003;35(6):484–91. https://doi.org/10.1080/00313020310001619127.

    Article  PubMed  Google Scholar 

  66. Cheng L, Montironi R, Davidson DD, Lopez-Beltran A. Staging and reporting of urothelial carcinoma of the urinary bladder. Mod Pathol 2009;22 Suppl 2:S70–95. https://doi.org/10.1038/modpathol.2009.1.

  67. Magers MJ, Lopez-Beltran A, Montironi R, Williamson SR, Kaimakliotis HZ, Cheng L. Staging of bladder cancer. Histopathology. 2019;74(1):112–34. https://doi.org/10.1111/his.13734.

    Article  PubMed  Google Scholar 

  68. Jimenez RE, Keane TE, Hardy HT, Amin MB. pT1 urothelial carcinoma of the bladder: criteria for diagnosis, pitfalls, and clinical implications. Adv Anat Pathol. 2000;7(1):13–25.

    Article  CAS  PubMed  Google Scholar 

  69. Ananthanarayanan V, Pan Y, Tretiakova M, Amin MB, Cheng L, Epstein JI, Grignon DJ, Hansel DE, Jimenez RE, McKenney JK, Montironi R, Oliva E, Osunkoya AO, Rao P, Reuter VE, Ro JY, Shen SS, Srigley JR, Tsuzuki T, Yao JL, Antic T, Haber M, Taxy JB, Paner GP. Influence of histologic criteria and confounding factors in staging equivocal cases for microscopic perivesical tissue invasion (pT3a): an interobserver study among genitourinary pathologists. Am J Surg Pathol. 2014;38(2):167–75. https://doi.org/10.1097/pas.0000000000000096.

    Article  PubMed  Google Scholar 

  70. Huang J, Fu J, Zhan H, Xie K, Liu B, Yang F, Lu Y, Zhou X. Analysis of the absence of the detrusor muscle in initial transurethral resected specimens and the presence of residual tumor tissue. Urol Int. 2012;89(3):319–25. https://doi.org/10.1159/000341103.

    Article  PubMed  Google Scholar 

  71. Mariappan P, Finney SM, Head E, Somani BK, Zachou A, Smith G, Mishriki SF, N’Dow J, Grigor KM. Good quality white-light transurethral resection of bladder tumours (GQ-WLTURBT) with experienced surgeons performing complete resections and obtaining detrusor muscle reduces early recurrence in new non-muscle-invasive bladder cancer: validation across time and place and recommendation for benchmarking. BJU Int. 2012;109(11):1666–73. https://doi.org/10.1111/j.1464-410X.2011.10571.x.

    Article  PubMed  Google Scholar 

  72. Mariappan P, Zachou A, Grigor KM. Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience. Eur Urol. 2010;57(5):843–9. https://doi.org/10.1016/j.eururo.2009.05.047.

    Article  PubMed  Google Scholar 

  73. Shoshany O, Mano R, Margel D, Baniel J, Yossepowitch O. Presence of detrusor muscle in bladder tumor specimens--predictors and effect on outcome as a measure of resection quality. Urol Oncol. 2014;32(1):40.e17-22. https://doi.org/10.1016/j.urolonc.2013.04.009.

    Article  PubMed  Google Scholar 

  74. Gakis G, Schilling D, Renninger M, Seibold J, Sievert KD, Stenzl A. Comparison of the new American joint committee on cancer substratification in node-negative pT2 urothelial carcinoma of the bladder: analysis of patient outcomes in a contemporary series. BJU Int. 2011;107(6):919–23. https://doi.org/10.1111/j.1464-410X.2010.09548.x.

    Article  PubMed  Google Scholar 

  75. Ghoneim MA, Abdel-Latif M, el-Mekresh M, Abol-Enein H, Mosbah A, Ashamallah A, el-Baz MA. Radical cystectomy for carcinoma of the bladder: 2,720 consecutive cases 5 years later. J Urol. 2008;180(1):121–7. https://doi.org/10.1016/j.juro.2008.03.024.

    Article  PubMed  Google Scholar 

  76. Sonpavde G, Khan MM, Svatek RS, Lee R, Novara G, Tilki D, Lerner SP, Amiel GE, Skinner E, Karakiewicz PI, Bastian PJ, Kassouf W, Fritsche HM, Izawa JI, Ficarra V, Dinney CP, Lotan Y, Fradet Y, Shariat SF. Prognostic risk stratification of pathological stage T2N0 bladder cancer after radical cystectomy. BJU Int. 2011;108(5):687–92. https://doi.org/10.1111/j.1464-410X.2010.09902.x.

    Article  PubMed  Google Scholar 

  77. Tilki D, Reich O, Karakiewicz PI, Novara G, Kassouf W, Ergun S, Fradet Y, Ficarra V, Sonpavde G, Stief CG, Skinner E, Svatek RS, Lotan Y, Sagalowsky AI, Shariat SF. Validation of the AJCC TNM substaging of pT2 bladder cancer: deep muscle invasion is associated with significantly worse outcome. Eur Urol. 2010;58(1):112–7. https://doi.org/10.1016/j.eururo.2010.01.015.

    Article  PubMed  Google Scholar 

  78. Milowsky MI, Rumble RB, Booth CM, Gilligan T, Eapen LJ, Hauke RJ, Boumansour P, Lee CT. Guideline on muscle-invasive and metastatic bladder cancer (European Association of Urology guideline): American society of clinical oncology clinical practice guideline endorsement. J Clin Oncol Off J Am Soc Clin Oncol. 2016;34(16):1945–52. https://doi.org/10.1200/jco.2015.65.9797.

    Article  Google Scholar 

  79. Witjes JA, Comperat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Van der Heijden AG, Sherif A. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol. 2014;65(4):778–92. https://doi.org/10.1016/j.eururo.2013.11.046.

    Article  PubMed  Google Scholar 

  80. Tretter EM, Ebel JJ, Pohar KS, Zynger DL. Does the gross prosector impact pT3 subclassification or lymph node counts in bladder cancer? Hum Pathol. 2017;61:190–8. https://doi.org/10.1016/j.humpath.2016.12.009.

    Article  PubMed  Google Scholar 

  81. Boudreaux KJ Jr, Chang SS, Lowrance WT, Rumohr JA, Barocas DA, Cookson MS, Smith JA Jr, Clark PE. Comparison of American joint committee on Cancer pathologic stage T3a versus T3b urothelial carcinoma: analysis of patient outcomes. Cancer. 2009;115(4):770–5. https://doi.org/10.1002/cncr.24110.

    Article  PubMed  Google Scholar 

  82. Quek ML, Stein JP, Clark PE, Daneshmand S, Miranda G, Cai J, Groshen S, Cote RJ, Lieskovsky G, Quinn DI, Skinner DG. Microscopic and gross extravesical extension in pathological staging of bladder cancer. J Urol. 2004;171(2 Pt 1):640–5. https://doi.org/10.1097/01.ju.0000108664.39035.51.

    Article  PubMed  Google Scholar 

  83. Quek ML, Stein JP, Clark PE, Daneshmand S, Miranda G, Cai J, Groshen S, Lieskovsky G, Quinn DI, Raghavan D, Skinner DG. Natural history of surgically treated bladder carcinoma with extravesical tumor extension. Cancer. 2003;98(5):955–61. https://doi.org/10.1002/cncr.11569.

    Article  PubMed  Google Scholar 

  84. Scosyrev E, Yao J, Messing E. Microscopic invasion of perivesical fat by urothelial carcinoma: implications for prognosis and pathology practice. Urology. 2010;76(4):908–13.; discussion 914. https://doi.org/10.1016/j.urology.2010.02.073.

    Article  PubMed  Google Scholar 

  85. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M, Raghavan D, Skinner DG. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol Off J Am Soc Clin Oncol. 2001;19(3):666–75. https://doi.org/10.1200/jco.2001.19.3.666.

    Article  CAS  Google Scholar 

  86. Tilki D, Svatek RS, Karakiewicz PI, Novara G, Seitz M, Sonpavde G, Gupta A, Kassouf W, Fradet Y, Ficarra V, Skinner E, Lotan Y, Sagalowsky AI, Stief CG, Reich O, Shariat SF. pT3 substaging is a prognostic indicator for lymph node negative urothelial carcinoma of the bladder. J Urol. 2010;184(2):470–4. https://doi.org/10.1016/j.juro.2010.04.007.

    Article  PubMed  Google Scholar 

  87. Edge SBBD, Compton CC. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  88. Zarei S, Frank I, Boorjian SA, Thompson RH, Kim S, Weight C, Tarrell R, Thapa P, Cheville JC. Prognostic significance of measured depth of invasion of urothelial carcinoma of the bladder compared to the 2010 American joint committee on Cancer pT2 and pT3 classifications. J Urol. 2012;188(5):1706–11. https://doi.org/10.1016/j.juro.2012.07.035.

    Article  PubMed  Google Scholar 

  89. Moschini M, Zamboni S, Mattei A, Baumeister P, Di Bona C, Cornelius J, Shariat SF, Freschi M, Zaffuto E, Salonia A, Montorsi F, Briganti A, Colombo R, Gallina A. Radical cystectomy in pathological T4a and T4b bladder cancer patients: is there any space for sub stratification? Urol Int. 2019;102(3):269–76. https://doi.org/10.1159/000493899.

    Article  PubMed  Google Scholar 

  90. Tilki D, Svatek RS, Karakiewicz PI, Isbarn H, Reich O, Kassouf W, Fradet Y, Novara G, Fritsche HM, Bastian PJ, Izawa JI, Stief CG, Ficarra V, Lerner SP, Schoenberg M, Dinney CP, Skinner E, Lotan Y, Sagalowsky AI, Shariat SF. Characteristics and outcomes of patients with pT4 urothelial carcinoma at radical cystectomy: a retrospective international study of 583 patients. J Urol. 2010;183(1):87–93. https://doi.org/10.1016/j.juro.2009.08.145.

    Article  PubMed  Google Scholar 

  91. Donat SM, Genega EM, Herr HW, Reuter VE. Mechanisms of prostatic stromal invasion in patients with bladder cancer: clinical significance. J Urol. 2001;165(4):1117–20.

    Article  CAS  PubMed  Google Scholar 

  92. Esrig D, Freeman JA, Elmajian DA, Stein JP, Chen SC, Groshen S, Simoneau A, Skinner EC, Lieskovsky G, Boyd SD, Cote RJ, Skinner DG. Transitional cell carcinoma involving the prostate with a proposed staging classification for stromal invasion. J Urol. 1996;156(3):1071–6.

    Article  CAS  PubMed  Google Scholar 

  93. Montironi R, Cheng L, Mazzucchelli R, Scarpelli M, Kirkali Z, Montorsi F, Lopez-Beltran A. Critical evaluation of the prostate from cystoprostatectomies for bladder cancer: insights from a complete sampling with the whole mount technique. Eur Urol. 2009;55(6):1305–9. https://doi.org/10.1016/j.eururo.2008.10.032.

    Article  PubMed  Google Scholar 

  94. Ayyathurai R, Gomez P, Luongo T, Soloway MS, Manoharan M. Prostatic involvement by urothelial carcinoma of the bladder: clinicopathological features and outcome after radical cystectomy. BJU Int. 2007;100(5):1021–5. https://doi.org/10.1111/j.1464-410X.2007.07171.x.

    Article  PubMed  Google Scholar 

  95. Knoedler JJ, Boorjian SA, Tollefson MK, Cheville JC, Thapa P, Tarrell RF, Frank I. Urothelial carcinoma involving the prostate: the association of revised tumour stage and coexistent bladder cancer with survival after radical cystectomy. BJU Int. 2014;114(6):832–6. https://doi.org/10.1111/bju.12486.

    Article  PubMed  Google Scholar 

  96. Njinou Ngninkeu B, Lorge F, Moulin P, Jamart J, Van Cangh PJ. Transitional cell carcinoma involving the prostate: a clinicopathological retrospective study of 76 cases. J Urol. 2003;169(1):149–52. https://doi.org/10.1097/01.ju.0000042810.43380.36.

    Article  CAS  PubMed  Google Scholar 

  97. Pagano F, Bassi P, Ferrante GL, Piazza N, Abatangelo G, Pappagallo GL, Garbeglio A. Is stage pT4a (D1) reliable in assessing transitional cell carcinoma involvement of the prostate in patients with a concurrent bladder cancer? A necessary distinction for contiguous or noncontiguous involvement. J Urol. 1996;155(1):244–7.

    Article  CAS  PubMed  Google Scholar 

  98. Vallo S, Gilfrich C, Burger M, Volkmer B, Boehm K, Rink M, Chun FK, Roghmann F, Novotny V, Mani J, Brisuda A, Mayr R, Stredele R, Noldus J, Schnabel M, May M, Fritsche HM, Pycha A, Martini T, Wirth M, Roigas J, Bastian PJ, Nuhn P, Dahlem R, Haferkamp A, Fisch M, Aziz A. Comparative analysis of the effect of prostatic invasion patterns on cancer-specific mortality after radical cystectomy in pT4a urothelial carcinoma of the bladder. Urol Oncol. 2016;34(10):432.e431-438. https://doi.org/10.1016/j.urolonc.2016.05.008.

    Article  Google Scholar 

  99. Patel AR, Cohn JA, Abd El Latif A, Miocinovic R, Steinberg GD, Paner GP, Hansel DE. Validation of new AJCC exclusion criteria for subepithelial prostatic stromal invasion from pT4a bladder urothelial carcinoma. J Urol. 2013;189(1):53–8. https://doi.org/10.1016/j.juro.2012.09.006.

    Article  PubMed  Google Scholar 

  100. Daneshmand S, Stein JP, Lesser T, Quek ML, Nichols PW, Miranda G, Cai J, Groshen S, Skinner EC, Skinner DG. Prognosis of seminal vesicle involvement by transitional cell carcinoma of the bladder. J Urol. 2004;172(1):81–4. https://doi.org/10.1097/01.ju.0000132131.64727.ff.

    Article  PubMed  Google Scholar 

  101. Murphy WM, Crissman JD, Johansson SL, Ayala AG. Recommendations for the reporting of urinary bladder specimens that contain bladder neoplasms. Mod Pathol. 1996;9(7):796–8.

    CAS  PubMed  Google Scholar 

  102. May M, Brookman-May S, Burger M, Gilfrich C, Fritsche HM, Rink M, Chun F, Fisch M, Roghmann F, Noldus J, Mayr R, Pycha A, Novotny V, Wirth M, Vallo S, Haferkamp A, Roigas J, Brisuda A, Stredele R, Volkmer B, Dechet C, Schnabel M, Denzinger S, Stief CG, Bastian PJ, Aziz A. Concomitant seminal vesicle invasion in pT4a urothelial carcinoma of the bladder with contiguous prostatic infiltration is an adverse prognosticator for cancer-specific survival after radical cystectomy. Ann Surg Oncol. 2014;21(12):4034–40. https://doi.org/10.1245/s10434-014-3827-y.

    Article  PubMed  Google Scholar 

  103. You D, Kim SC, Jeong IG, Hong JH, Ro JY, Ahn H, Kim CS. Urothelial carcinoma of the bladder with seminal vesicle invasion: prognostic significance. BJU Int. 2010;106(11):1657–61. https://doi.org/10.1111/j.1464-410X.2010.09494.x.

    Article  PubMed  Google Scholar 

  104. Ali-El-Dein B, Abdel-Latif M, Mosbah A, Eraky I, Shaaban AA, Taha NM, Ghoneim MA. Secondary malignant involvement of gynecologic organs in radical cystectomy specimens in women: is it mandatory to remove these organs routinely? J Urol. 2004;172(3):885–7. https://doi.org/10.1097/01.ju.0000133986.29257.bf.

    Article  PubMed  Google Scholar 

  105. Barocas DA, Patel SG, Chang SS, Clark PE, Smith JA Jr, Cookson MS. Outcomes of patients undergoing radical cystoprostatectomy for bladder cancer with prostatic involvement on final pathology. BJU Int. 2009;104(8):1091–7. https://doi.org/10.1111/j.1464-410X.2009.08558.x.

    Article  PubMed  Google Scholar 

  106. Chen ME, Pisters LL, Malpica A, Pettaway CA, Dinney CP. Risk of urethral, vaginal and cervical involvement in patients undergoing radical cystectomy for bladder cancer: results of a contemporary cystectomy series from M.D. Anderson Cancer Center. J Urol. 1997;157(6):2120–3.

    Article  CAS  PubMed  Google Scholar 

  107. Groutz A, Gillon G, Konichezky M, Shimonov M, Winkler H, Livne PM, Baniel J. Involvement of internal genitalia in female patients undergoing radical cystectomy for bladder cancer: a clinicopathologic study of 37 cases. Int J Gynecol Cancer. 1999;9(4):302–6. https://doi.org/10.1046/j.1525-1438.1999.99039.x.

    Article  PubMed  Google Scholar 

  108. Salem H, El-Mazny A. A clinicopathologic study of gynecologic organ involvement at radical cystectomy for bladder cancer. Int J Gynaecol Obstet. 2011;115(2):188–90. https://doi.org/10.1016/j.ijgo.2011.05.026.

    Article  PubMed  Google Scholar 

  109. Shen SS, Lerner SP, Muezzinoglu B, Truong LD, Amiel G, Wheeler TM. Prostatic involvement by transitional cell carcinoma in patients with bladder cancer and its prognostic significance. Hum Pathol. 2006;37(6):726–34. https://doi.org/10.1016/j.humpath.2006.01.027.

    Article  PubMed  Google Scholar 

  110. Varkarakis IM, Pinggera G, Antoniou N, Constantinides K, Chrisofos M, Deliveliotis C. Pathological review of internal genitalia after anterior exenteration for bladder cancer in women. Evaluating risk factors for female organ involvement. Int Urol Nephrol. 2007;39(4):1015–21. https://doi.org/10.1007/s11255-006-9158-6.

    Article  PubMed  Google Scholar 

  111. Galsky MD, Moshier E, Krege S, Lin CC, Hahn N, Ecke T, Sonpavde G, Godbold J, Oh WK, Bamias A. Nomogram for predicting survival in patients with unresectable and/or metastatic urothelial cancer who are treated with cisplatin-based chemotherapy. Cancer. 2013;119(16):3012–9. https://doi.org/10.1002/cncr.28146.

    Article  CAS  PubMed  Google Scholar 

  112. Hansel DE, Paner GP, Nese N, Amin MB. Limited smoothelin expression within the muscularis mucosae: validation in bladder diverticula. Hum Pathol. 2011;42(11):1770–6. https://doi.org/10.1016/j.humpath.2011.02.022.

    Article  PubMed  Google Scholar 

  113. Golijanin D, Yossepowitch O, Beck SD, Sogani P, Dalbagni G. Carcinoma in a bladder diverticulum: presentation and treatment outcome. J Urol. 2003;170(5):1761–4. https://doi.org/10.1097/01.ju.0000091800.15071.52.

    Article  PubMed  Google Scholar 

  114. Hu B, Satkunasivam R, Schuckman A, Miranda G, Cai J, Daneshmand S. Urothelial carcinoma in bladder diverticula: outcomes after radical cystectomy. World J Urol. 2015;33(10):1397–402. https://doi.org/10.1007/s00345-014-1472-5.

    Article  PubMed  Google Scholar 

  115. Idrees MT, Alexander RE, Kum JB, Cheng L. The spectrum of histopathologic findings in vesical diverticulum: implications for pathogenesis and staging. Hum Pathol. 2013;44(7):1223–32. https://doi.org/10.1016/j.humpath.2012.11.005.

    Article  PubMed  Google Scholar 

  116. Tamas EF, Stephenson AJ, Campbell SC, Montague DK, Trusty DC, Hansel DE. Histopathologic features and clinical outcomes in 71 cases of bladder diverticula. Arch Pathol Lab Med. 2009;133(5):791–6. https://doi.org/10.1043/1543-2165-133.5.791.

    Article  PubMed  Google Scholar 

  117. Walker NF, Gan C, Olsburgh J, Khan MS. Diagnosis and management of intradiverticular bladder tumours. Nat Rev Urol. 2014;11(7):383–90. https://doi.org/10.1038/nrurol.2014.131.

    Article  PubMed  Google Scholar 

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Choi, E., Park, S., Ro, J.Y. (2021). AJCC Staging of Bladder Cancers. In: Zhou, H., Guo, C.C., Ro, J.Y. (eds) Urinary Bladder Pathology. Springer, Cham. https://doi.org/10.1007/978-3-030-71509-0_18

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