MP49-08 PROGNOSTIC SIGNIFICANCE OF DEPTH OF INVASION IN TRANSURETHRAL RESECTION OF BLADDER TUMOR SPECIMENS.

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2016MP49-08 PROGNOSTIC SIGNIFICANCE OF DEPTH OF INVASION IN TRANSURETHRAL RESECTION OF BLADDER TUMOR SPECIMENS. Mahmut Akgul, Bream Matthew, Nafiseh Janaki, Hammad Tashkandi, Lee Ponsky, and Gregory MacLennan Mahmut AkgulMahmut Akgul More articles by this author , Bream MatthewBream Matthew More articles by this author , Nafiseh JanakiNafiseh Janaki More articles by this author , Hammad TashkandiHammad Tashkandi More articles by this author , Lee PonskyLee Ponsky More articles by this author , and Gregory MacLennanGregory MacLennan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.421AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Depth of invasion in transurethral resection of bladder (TURB) biopsies of T1 urothelial cancer has previously been evaluated for subclassification. This has been done by measuring depth of lamina propria (LP) invasion or by identifying muscularis mucosa invasion, however these are affected by tissue orientation, LP variation, and inconclusive presence of muscularis mucosa. Identifying tumor that is adjacent to detrusor muscle (TADM) is not affected by orientation or LP size and may be a better histologic indicator of advanced T1 disease. METHODS A language search of our departmental pathology archives from 1995-2015 using “transurethral resection” and “bladder” identified all 2786 TURB cases. Pathologic and clinical records were reviewed, and only those with T1 cancer at initial resection, urothelial histology, detrusor muscle (DM) present in the biopsy, and adequate clinical records were included. All available slides were reviewed, and patients were classified into two groups: LP invasion with TADM (group 1), or any other LP invasion without TADM (group 2). Further clinical data was obtained including, age, gender, treatment and disease course including all subsequent resections or cystectomy, and status of nodal or metastatic disease. Recurrence (subsequent resections with T1 or higher), progression (presence of T2 or higher or nodal/metastatic disease), and rates of cystectomy were compared using Fisher's exact and chi-square tests. RESULTS A total of 105 patients met inclusion criteria. The male:female ratio was 3.4:1, and median age was 74. Twenty patients had TADM (group 1), and 85 patients did not have TADM (group 2). Disease recurrence was higher in group 1 (15 of 20, 75%) compared to group 2 (32 of 85, 37%), p=0.005. Disease progression was higher in group 1 (14 of 20, 70%) compared to group 2 (19 of 85, 22%), p=0.04. Rates of lymph node positive disease at cystectomy or development of metastatic disease were significantly higher in group 1 (8 of 20, 40%) than in group 2 (9 of 85, 10%), p=0.003. The cystectomy rate was higher in group 1 than group 2, although the difference was not statistically significant [group 1: 8 of 20 (40%) vs group 2: 22 of 85 (25%), p=0.09]. CONCLUSIONS This retrospective analysis of T1 disease in TURB specimens showed that LP invasion with TADM is associated with higher rates of disease recurrence and progression to muscle invasion or nodal/metastatic disease. This means of subclassifying T1 bladder cancers is not affected by tissue orientation, variations in LP depth or presence of a muscularis mucosa layer, and may be a better prognostic tool. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e667 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Mahmut Akgul More articles by this author Bream Matthew More articles by this author Nafiseh Janaki More articles by this author Hammad Tashkandi More articles by this author Lee Ponsky More articles by this author Gregory MacLennan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...