The significance of ureteral sampling at radical cystectomy in bladder cancer patients

Abstract

4675 Background: In the current literature there are no clear guidelines for ureteral margins sampling at radical cystectomy and limited data regarding the contribution of ureteral assesment in outcome prediction of bladder cancer patients. This study was aimed to assess the use of frozen and permanent sections and their contribution in predicting recurrence and survival. Methods: We have reviewed an institutional data-base of patients who underwent radical cystectomy and recorded frozen section and permanent section results of the last ureteral segment, taken before anastomosing the ureters. We compared the results of the frozen section analysis to the permanent and calculated the sensitivity, specificity and negative and positive predictive values. We calculated the hazard ratio for upper tract recurrence using Cox model analysis and the added predictive value of abnormal ureters on upper-tract recurrence and survival (Harrell’s C test). Results: We identified, 1,207 patients who underwent cystectomy for bladder cancer in the years 1984–2004, 966 of them underwent ureteral sampling. The incidence of ureteral abnormalities was 125/966 patients (13%). Frozen section was available for 301 patients and correctly diagnosed malignancy in 24/40 of the cases. The sensitivity, specificity, positive predictive value and negative predictive value were 60%, 99.8%, 96% and 96.5%, respectively. Using Cox analysis corrected for age, pathological stage and grade, ureteral abnormalities were found to be a predictor of decreased time interval for upper tract recurrence (hazard ratio 3.0, CI: 1.2–7.3, p=0.01), but given the rarity of ureteral abnormalities, the contribution of ureteral margins sampling uniformly applied to all patients was minimal (68% vs. 66.7% predictive accuracy). Ureteral margins abnormalities were not predictive of overall survival. Conclusions: Ureteral margins sampling, applied uniformly to all bladder cancer patients undergoing cystectomy, has a questionable added value in prediction of upper tract recurrence and survival. Characterization of patients who may benefit from ureteral sampling is required to establish ureteral sampling criteria at radical cystectomy for better patients selection. No significant financial relationships to disclose.