MP83-13 CLINICAL T1 UROTHELIAL CARCINOMA: OUTCOMES FOLLOWING RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive II1 Apr 2018MP83-13 CLINICAL T1 UROTHELIAL CARCINOMA: OUTCOMES FOLLOWING RADICAL CYSTECTOMY Daniel Zainfeld, Saum Ghodoussipour, Shane Pearce, Ankeet Shah, Gus Miranda, Jie Cai, Anne Schuckman, Hooman Djaladat, and Siamak Daneshmand Daniel ZainfeldDaniel Zainfeld More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , Shane PearceShane Pearce More articles by this author , Ankeet ShahAnkeet Shah More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2761AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the absence of predictive biomarkers, management of bladder cancer is determined by clinical findings and pathologic staging from endoscopic tumor resections. Conservative management of non-muscle invasive disease may delay or prevent definitive treatment in many patients yet the morbidity of radical cystectomy is significant. We sought to determine predictors of pathologic outcomes among patients with clinical T1 urothelial carcinoma and to better characterize this patient cohort. METHODS Retrospective review of our IRB approved prospectively maintained bladder cancer database was completed. All patients with worst clinical stage T1 urothelial carcinoma who underwent radical cystectomy and pelvic lymph node dissection were identified. Patients with any prior detrusor involvement or with variant histology patterns were excluded from analysis. Patient demographics as well as clinical and pathologic characteristics were assessed. Oncologic outcomes in the form of recurrence free survival and overall survival were evaluated. RESULTS 603 patients underwent radical cystectomy between 1983 and 2016 for clinical stage T1 urothelial carcinoma. 379 (62.85%) did not receive intravesical chemotherapy and proceeded directly to radical cystectomy. However, 287 (47.6%) underwent at least two TURBTs prior to cystectomy without evidence of cT2 disease. Final pathology revealed 242 (40.13%) with more extensive disease than that suggested by clinical stage including 75 (12.44%) with lymph node metastasis. Among 211 patients in whom presence of detrusor was confirmed at resection, 64 (30.34%) were upstaged at cystectomy including 14 (6.64%) with lymph node metastasis. Recurrence free survival and overall survival were both significantly impacted by pathologic stage as determined by log-rank test (p<0.0001). Lymphovascular invasion on TURBT was significantly associated with incidence of lymph node metastasis (p<0.0001) as was presence of CIS (p=0.0465). CONCLUSIONS Urothelial carcinoma represents an aggressive malignancy with significant mortality though curable in the localized setting. Clinical staging by TURBT cannot adequately identify risk factors for progressive or metastatic disease. Optimal management of non-muscle invasive urothelial carcinoma demands a nuanced approach to risk stratification. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1121 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniel Zainfeld More articles by this author Saum Ghodoussipour More articles by this author Shane Pearce More articles by this author Ankeet Shah More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Anne Schuckman More articles by this author Hooman Djaladat More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...