Abstract
Background: A significant number of patients with advanced urothelial cell carcinoma are under- or over-staged. Implementation of clinical variables could be useful for improving the accuracy of clinical staging. Aim: To explore the differences between clinical and pathological diagnosis in patients with UCC, and to identify clinical variables that might play a role in under- or overstating. Materials: A total of 553 patients after radical cystectomy were included in the analysis. Clinical stage of the disease was diagnosed according to CT or MRI in relation to clinical data. Results: Higher clinical stage correlated with a higher pathological stage (p < 0.00005), but in 306 patients did not correspond (142 patients were under-staged and 164 over-staged). Over half (54.2%) of the patients staged as cT1–cT2 were misdiagnosed: 137 patients were under-staged and 133 over-staged. Hydronephrosis was associated with a higher pathological stage (p < 0.000005), mostly pT3–4 (45.13% had pT4 disease) and higher risk of nodal metastasis (p = 0.0028). The highest percentage of PSM was found in patients with pT4 (33.12%). Conclusions: Clinical staging of bladder cancer is poorly executed, with one third of patients under-staged and one third over-staged. To improve accuracy, we recommend a multimodal approach, combining histopathological evaluation with results of imaging studies.
Highlights
The Urothelial cell carcinoma (UCC) is the most common neoplasm of the urinary tract, with 380,000 new cases reported each year worldwide [1,2]
The cTNM stage aims to provide a clear view of the extent of the disease in order to guide primary treatment, while the pTNM assessment provides precise data for estimating prognosis and planning further treatment
Indications for radical cystectomy, in accordance with the guidelines of the European Association of Urology (EAU), were as follows: urothelial cT2–cT4a disease or non-invasive papillary cancer that could not be controlled by transurethral resection of the bladder tumor [7]
Summary
The Urothelial cell carcinoma (UCC) is the most common neoplasm of the urinary tract, with 380,000 new cases reported each year worldwide [1,2]. The cTNM stage (which is based on examination, imaging, and transurethral resection of the tumor with biopsy) aims to provide a clear view of the extent of the disease in order to guide primary treatment, while the pTNM assessment provides precise data for estimating prognosis and planning further treatment. The commonly used imaging methods (MRI, CT) tend to diagnose only locally-advanced disease, which is insufficient for the implementation of conservative treatment [6]. To overcome this challenge, we hypothesize that a multimodal approach to the clinical staging of UCC is needed to eliminate bias and to help to stratify patients into specific risk categories for achieving optimal outcomes while avoiding overtreatment. We aimed to investigate the clinical variables that might play a role in under- or overstating the extent of the disease
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