1900 WORTH A SECOND LOOK: RATES OF UPSTAGING AT THE TIME OF RADICAL CYSTECTOMY AFTER RESTAGING TURBT FOR PERSISTENT T1 UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyBladder Cancer: Metastatic Disease/Staging1 Apr 20121900 WORTH A SECOND LOOK: RATES OF UPSTAGING AT THE TIME OF RADICAL CYSTECTOMY AFTER RESTAGING TURBT FOR PERSISTENT T1 UROTHELIAL CARCINOMA Jacob Ark, Daniel Barocas, Kirk Keegan, Todd Morgan, Matthew Resnick, Chaochen You, Michael Cookson, David Penson, Rodney Davis, Peter Clark, Joseph Smith, and Sam Chang Jacob ArkJacob Ark Nashville, TN More articles by this author , Daniel BarocasDaniel Barocas Nashville, TN More articles by this author , Kirk KeeganKirk Keegan Nashville, TN More articles by this author , Todd MorganTodd Morgan Nashville, TN More articles by this author , Matthew ResnickMatthew Resnick Nashville, TN More articles by this author , Chaochen YouChaochen You Nashville, TN More articles by this author , Michael CooksonMichael Cookson Nashville, TN More articles by this author , David PensonDavid Penson Nashville, TN More articles by this author , Rodney DavisRodney Davis Nashville, TN More articles by this author , Peter ClarkPeter Clark Nashville, TN More articles by this author , Joseph SmithJoseph Smith Nashville, TN More articles by this author , and Sam ChangSam Chang Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2056AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES For clinical T1 bladder cancers, restaging transurethral resection of bladder tumors (TURBT) attempts to improve staging accuracy and decrease understaging. We examined pathologic stage of patients after radical cystectomy (RC) with cT1 bladder cancer on initial biopsy and subsequent restaging TURBT. METHODS Among the 1239 radical cystectomy procedures performed between 2000 and 2011, we focused on 300 consecutive patients with an initial diagnosis of cT1 urothelial carcinoma (UC). From these, we selected cases that underwent restaging TURBT prior to RC and had no more than cT1 disease. Restaging TURBT was defined as a bladder resection or biopsy, performed within 3 months of a prior TURBT and within 90 days of RC, without the use of intervening intravesical therapy. Variables evaluated were age; gender; race; number of prior resections; tumor grade; multifocality; presence of muscle, carcinoma in situ, or lymphovascular invasion on biopsy; pre-operative hydronephrosis; and prior history of intravesical therapy. RESULTS 68 patients met our inclusion criteria of restaging TURBT who then underwent radical cystectomy. Their median age was 67.4 years (interquartile range [IQR] 60.7-70.0 years). Of these, 36 (52%) demonstrated pathologic upstaging after RC. At restaging TURBT, muscularis propria was present in 92% of these patients but was uninvolved. Hydronephrosis was appreciated on pre-operative imaging in 17% of patients who were upstaged compared with 6% patients who were not upstaged. None of the clinical variables evaluated were statistically significant predictors of tumor upstaging at the time of RC. CONCLUSIONS Despite restaging TURBT, a high rate of clinical upstaging at RC still exists. These data demonstrate that over 50% of patients with cT1 tumors have pathologic muscle-invasive disease at RC, yet identifying these patients based on clinicopathologic criteria is not currently feasible. Clinicians must maintain a high index of suspicion for bladder cancer progression, even if a restaging TURBT reveals cT1 disease. Factors influencing the diagnostic evaluation and timely treatment for these patients continue to merit further investigation. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e766 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacob Ark Nashville, TN More articles by this author Daniel Barocas Nashville, TN More articles by this author Kirk Keegan Nashville, TN More articles by this author Todd Morgan Nashville, TN More articles by this author Matthew Resnick Nashville, TN More articles by this author Chaochen You Nashville, TN More articles by this author Michael Cookson Nashville, TN More articles by this author David Penson Nashville, TN More articles by this author Rodney Davis Nashville, TN More articles by this author Peter Clark Nashville, TN More articles by this author Joseph Smith Nashville, TN More articles by this author Sam Chang Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...