1883 DOES THE EXTENT OF MICROPAPILLARY COMPONENT IMPACT CLINICAL OUTCOME?

Abstract

You have accessJournal of UrologyBladder Cancer: Metastatic Disease + Staging1 Apr 20131883 DOES THE EXTENT OF MICROPAPILLARY COMPONENT IMPACT CLINICAL OUTCOME? Daniel Willis, Mario Fernandez, Charles Guo, Bogdan Czerniak, Rian Dickstein, Parikh Sahil, Louis Pisters, H. Barton Grossman, Colin Dinney, and Ashish Kamat Daniel WillisDaniel Willis Houston, TX More articles by this author , Mario FernandezMario Fernandez Houston, TX More articles by this author , Charles GuoCharles Guo Houston, TX More articles by this author , Bogdan CzerniakBogdan Czerniak Houston, TX More articles by this author , Rian DicksteinRian Dickstein Houston, TX More articles by this author , Parikh SahilParikh Sahil Houston, TX More articles by this author , Louis PistersLouis Pisters Houston, TX More articles by this author , H. Barton GrossmanH. Barton Grossman Houston, TX More articles by this author , Colin DinneyColin Dinney Houston, TX More articles by this author , and Ashish KamatAshish Kamat Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2302AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It has been postulated that the clinical behavior of micropapillary bladder cancer (MPBC) is dependent on the extent of MPBC component relative to conventional urothelial carcinoma. As no formal definition of what constitutes focal or extensive MPBC exists, we sought to quantify focal vs. extensive MPBC and study the impact of extent of disease on clinical outcome. METHODS An IRB approved institutional review of our bladder cancer database identified 253 patients with MPBC described as being “focal” or “extensive” at the time of TUR. In 40 of these cases, the percentage of MPBC was numerically quantified by a GU pathologist. Clinical, pathologic, and outcome data were correlated with extent of disease using chi square test, Kaplan-Meier estimator, and Cox Regression analysis. RESULTS Overall, 169 (67%) patients were reported as having focal MPBC and 84 (33%) patients as extensive micropapillary histology. In this group, the median disease specific survival (DSS) for focal and extensive MPBC was 59 vs. 25 months, respectively (p=0.004). Extensive MPBC continued to predict DSS on multivariate analysis after including the following covariates: age, cT stage, cN status, and lymphovascular invasion (LVI) (p=0.028). Analysis of the 40 patients with a quantified percentage of MPBC demonstrated that a cutoff of 15% had the greatest association with survival and cT stage (p<0.001). Among these, 18 (45%) had ≤15% and 22 (55%) had >15% component of MPBC. The 5 year estimated DSS was 77% and 13% for ≤15% and >15% MPBC, respectively (p<0.001, Figure 1). Further comparison between patients with ≤15% MPBC vs. >15% MPBC demonstrated relevant differences in LVI (17% vs. 57%, p=0.01), lymph node metastasis at presentation (11% vs. 43%, p=0.03), distant metastatic disease at presentation (6% vs. 32%, p=0.04), and cT stage (cT1: 50% vs. 9%; cT2: 44% vs. 64%; cT3: 6% vs. 14%; cT4: 0% vs. 14%; p=0.02), respectively. CONCLUSIONS Extensive micropapillary architecture in the TUR specimen is associated with more advanced disease and a worse disease specific survival when compared to focal MPBC. Our review suggests that any MPBC comprising greater than 15% of the TUR specimen may be considered as “extensive” micropapillary disease, and treated as such. Further pathologic review is underway to further validate this definition of focal vs. extensive MPBC. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e772 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Willis Houston, TX More articles by this author Mario Fernandez Houston, TX More articles by this author Charles Guo Houston, TX More articles by this author Bogdan Czerniak Houston, TX More articles by this author Rian Dickstein Houston, TX More articles by this author Parikh Sahil Houston, TX More articles by this author Louis Pisters Houston, TX More articles by this author H. Barton Grossman Houston, TX More articles by this author Colin Dinney Houston, TX More articles by this author Ashish Kamat Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...