1876 A POST-CHEMOTHERAPY RESTAGING EVALUATION IMPROVES THE CORRELATION OF CLINICAL AND PATHOLOGICAL STAGE IN PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY AND RADICAL CYSTECTOMY FOR BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Metastatic Disease + Staging1 Apr 20131876 A POST-CHEMOTHERAPY RESTAGING EVALUATION IMPROVES THE CORRELATION OF CLINICAL AND PATHOLOGICAL STAGE IN PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY AND RADICAL CYSTECTOMY FOR BLADDER CANCER Adam Reese, Mark Ball, Trinity Bivalacqua, George Netto, and Mark Schoenberg Adam ReeseAdam Reese Baltimore, MD More articles by this author , Mark BallMark Ball Baltimore, MD More articles by this author , Trinity BivalacquaTrinity Bivalacqua Baltimore, MD More articles by this author , George NettoGeorge Netto Baltimore, MD More articles by this author , and Mark SchoenbergMark Schoenberg Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2295AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In patients undergoing radical cystectomy (RC) for bladder cancer, discrepancies between the clinical and pathological stage of the tumor are common. In patients treated with neoadjuvant chemotherapy (NAC) at our institution, we routinely perform a restaging evaluation after NAC and before proceeding to RC. We investigated whether restaging improves the correlation between clinical and pathological stage in patients treated the NAC. METHODS We identified patients in our institutional bladder cancer database who underwent NAC and RC between January 2011 and July 2012. After completing NAC, patients underwent a restaging examination that included chest x-ray or chest CT, cross-sectional imaging of the abdomen and pelvis (CT or MRI), endoscopic examination of the bladder under anesthesia, and bimanual examination. Clinical stage was assigned at initial presentation and on restaging examination, and compared to the pathological stage after RC to determine rates of up- and down-staging. A multivariable logistic regression model was performed to identify factors associated with pathological stage after RC. RESULTS 43 patients underwent NAC followed by RC. The table shows how initial clinical stage, and clinical stage on post-NAC restaging, correlate with pathological stage after RC. When comparing the initial clinical stage to pathological stage, 28 patients (65.1%) were downstaged, 7 patients (16.3%) were upstaged, and the two stages were similar in 8 patients (18.6%). When comparing the post-NAC clinical stage to the pathological stage, 12 patients (27.9%) were downstaged, 14 patients (32.6%) were upstaged, and the two stages were similar in 17 patients (39.5%). On logistic regression analysis, post-NAC clinical stage (p<0.01), but not initial clinical stage (p=0.40), was significantly associated with pathological stage after RC. CONCLUSIONS A restaging evaluation performed after the completion of NAC improves the correlation between clinical and pathological stage of bladder tumors, and thus allows for a more accurate assessment of patient prognosis prior to RC. Further investigation is needed to determine whether this improved correlation justifies a restaging evaluation in all patients. Pathological Stage After RC pT0 pTIS/Ta/T1 pT2 pT3 pT4 Total Clinical Stage at Diagnosis cT1 0 0 1 0 0 1 cT2 6 10 6 1 4 27 cT3 3 4 3 2 1 13 cT4 1 1 0 0 0 2 Total 10 15 10 3 5 43 Clinical Stage After Chemotherapy cT0 6 6 3 1 1 17 cT1 0 4 0 0 0 4 cT2 3 5 4 1 0 13 cT3 1 0 3 1 2 7 cT4 0 0 0 0 2 2 Total 10 15 10 3 5 43 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e769 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Reese Baltimore, MD More articles by this author Mark Ball Baltimore, MD More articles by this author Trinity Bivalacqua Baltimore, MD More articles by this author George Netto Baltimore, MD More articles by this author Mark Schoenberg Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...