Abstract

You have accessJournal of UrologyBladder Cancer: Metastatic Disease/Staging1 Apr 20121910 THE IMPACT OF ACCURATE STAGING ON BLADDER CANCER SURVIVAL: A PROCESS-OUTCOMES LINK Karim Chamie, Jeffrey C. Bassett, Timothy J. Daskivich, Meryl Leventhal, Dennis Deapen, and Mark S. Litwin Karim ChamieKarim Chamie Los Angeles, CA More articles by this author , Jeffrey C. BassettJeffrey C. Bassett Los Angeles, CA More articles by this author , Timothy J. DaskivichTimothy J. Daskivich Los Angeles, CA More articles by this author , Meryl LeventhalMeryl Leventhal Los Angeles, CA More articles by this author , Dennis DeapenDennis Deapen Los Angeles, CA More articles by this author , and Mark S. LitwinMark S. Litwin Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2066AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor muscle at diagnostic TURBT is often used as a surrogate of resection quality. We examined the association of surgical and pathology quality in reference to the initial diagnostic resection with survival among subjects diagnosed with non-muscle-invasive bladder cancer. METHODS We retrospectively reviewed the medical records of all individuals age 18 or older with an incident diagnosis of urothelial non-muscle-invasive bladder cancer between 2004 and 2005 within the confines of the Los Angeles SEER Registry. We recorded patient age, gender, race, marital status, socioeconomic and insurance status, tumor histology, grade, and stage, operating urologist and reporting pathologist volume, institution type, the presence/mention of detrusor muscle in the initial resection specimen, and vital status. After adjusting for confounding using a propensity score-weighted approach competing-risks regression analysis, we determined whether surgical and pathology quality were associated with cancer-specific survival. RESULTS We identified 1,865 individuals, 335 urologists, and 278 pathologists. The cohort was comprised of 1,180 (63.3%) individuals with low-grade and 685 (36.7%) with high-grade disease. We identified 33 (2.8%) bladder cancer-related deaths among those with low-grade and 94 (13.7%) among those with high-grade disease. Muscle was reported as present in 972 (52.1%), reported as absent in 564 (30.2%), and not mentioned in 329 (17.7%) of the initial pathology reports. The incidence of detrusor muscle sampling did not differ according to grade or stage. Among subjects with high-grade disease, a higher hazard of cancer-specific mortality was found with advancing age (76–85), stage (Tis and T1), and among those where detrusor muscle was absent (HR 1.65; 95% CI 1.05–2.59) or not mentioned (HR 2.87: 95% CI 1.44–5.72) in the initial diagnostic pathology report. The 5-year cancer-specific mortality was 8.0%, 13.0%, and 21.5% among those where muscle present, absent, and not mentioned, respectively. CONCLUSIONS Inadequate staging and poor pathology reporting are associated with a higher risk of bladder cancer-related deaths among those with high-grade disease. Since urologists were unable to discern between high or low grade, we contend that all patients with bladder cancer should undergo a complete endoscopic resection with detrusor muscle sampling (and appropriate pathology reporting) at diagnosis. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e770 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karim Chamie Los Angeles, CA More articles by this author Jeffrey C. Bassett Los Angeles, CA More articles by this author Timothy J. Daskivich Los Angeles, CA More articles by this author Meryl Leventhal Los Angeles, CA More articles by this author Dennis Deapen Los Angeles, CA More articles by this author Mark S. Litwin Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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