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Abstract

We greatly appreciate the thoughtful comments of the guest reviewer. Both use of adjuvant chemotherapy and lack of central histology review are important considerations in the context of this study. In our SEER cohort, patients with pT3a disease had inferior survival relative to pT2b disease of the same nodal status, despite possibly receiving more aggressive therapy. However, the use of adjuvant chemotherapy in our study population for node-negative disease was likely low (probably around 10% for pT3 N0, and almost certainly lower for pT2b N0). 1 David K.A. Milowsky M.I. Ritchey J. et al. Low incidence of perioperative chemotherapy for stage III bladder cancer 1998-2003: a report from the National Cancer Data Base. J Urol. 2007; 178: 451-454 Abstract Full Text Full Text PDF PubMed Scopus (203) Google Scholar It is possible that more frequent use of adjuvant chemotherapy for extravesical tumors in some academic centers could attenuate the adverse effect of pT3a disease on survival (relative to pT2b disease). Editorial CommentUrologyVol. 76Issue 4PreviewThis paper assesses the incidence of nodal metastases and prognostic implications of pathologic substaging of pathologic stage T2b and T3 urothelial carcinoma of the bladder using SEER registry data. The authors provide an excellent review of the topic in the introduction, and place the subject in the proper context of decision making regarding prognosis and potential need for adjuvant chemotherapy. Full-Text PDF