Markus Eckstein, Senior Physician/Pathologist and Clinician Scientist at the University Hospital Erlangen, shared on X:
“pT1 bladder cancer substaging: invasive extent and anatomical depth describe different features.
- Bertz: focal vs extensive invasion by HPF.
- T1m/e: a single small invasive focus vs larger or multiple foci.
- Anatomical substaging: invasion relative to the muscularis mucosae – definitions differ between two- and three-tier systems.
Asimakopoulos et al. found better PFS discrimination with m/e than a/b/c (C-index 0.700 vs 0.612). Yet Kläger et al. found anatomical substaging prognostic for progression, while m/e was not.
The m/e rule is conceptually simpler, but no method consistently outperforms the others. Substaging adds prognostic information; these studies do not establish benefit from choosing BCG or cystectomy on substage alone.
Prospective validation of either algorithm is lacking in standardized good clinical trials – so potential for decision making is unclear. ”
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