You have accessJournal of UrologyBladder Cancer: Superficial1 Apr 20101349 DOES THE PRESENCE OF MUSCULARIS PROPRIA ON BIOPSY AFFECT THE RATE OF UPSTAGING IN T1 BLADDER CANCER Trushar Patel, Greg Hruby, Matt Woznitzer, Mitchell C. Benson, and James Mckiernan Trushar PatelTrushar Patel More articles by this author , Greg HrubyGreg Hruby More articles by this author , Matt WoznitzerMatt Woznitzer More articles by this author , Mitchell C. BensonMitchell C. Benson More articles by this author , and James MckiernanJames Mckiernan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.976AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES High grade T1 urothelial carcinoma represents a difficult management decision. A significant percentage of these patients will eventually progress to muscle invasive disease, but clinical understaging of T1 disease can delay definite therapy, which can potentially affect survival. Pathological upgrading during radical cystectomy (RC) in patients with high grade T1 disease is not uncommon with reported rates of 27%-30%. Current guidelines recommend restaging transurethral resection when muscularis propria (MP) is absent on biopsy. Our aim was to determine how the presence of MP on T1 biopsy specimens affects the rate of upstaging at RC as compared to when it is absent. METHODS Patients were retrospectively identified from the IRB approved Columbia University Urologic Oncology Database. From January 1986 to October 2009 a total of 576 patients diagnosed with T1-T4, N0-N1, M0 bladder cancer who underwent RC within 4 months of their last biopsy were identified. Patients were excluded from the study if there was evidence of muscle invasion (n = 452), and neoadjuvant chemotherapy (n = 10). Patients were stratified based on the presence of MP on T1 biopsy specimen and the rate of upstaging as defined as any tumor T2 or greater, N+, or M+ disease at RC was assessed. RESULTS Of the 114 patients evaluated in this study, 24 (20.2%) did not have MP on their T1 biopsy before RC. Compared to those with MP present on their biopsy there was no significant difference with respect to age, gender, race, smoking history, and adjuvant chemotherapy use. At RC a total of 64 (56%) patients were upstaged from their previous of biopsy. The rate of upstaging (>=pT2) stratified by the presence of MP on biopsy was 50% and 78%, respectively (p = .0.017). Upstaging to >=T3 disease was found in 28.6% (26/91) and 65.2% (15/23) of patients with and without MP on biopsy, respectively (p = 0.005). The lack of MP on biopsy was not associated with margin status, lymphovascular invasion, or nodal metastasis at time of RC. On univariate analysis lack of MP on biopsy was associated with an increased risk of upstaging (HR 3.52, p = 0.021, CI 1.2-10.3), however did not reach significance as an independent predictor (HR 2.9, p = 0.056, CI 0.97-8.9). At a mean follow-up of 33.5 months, there was no difference with respect to disease specific (p = 0.41) and overall survival (p = 0.68) between groups. CONCLUSIONS The lack of MP on biopsy for T1 bladder cancer portends a high likelihood of upstaging at RC, however the presence of MP does not obviate such risk. The importance of re-staging resection for T1 disease is highlighted by these findings. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e521 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Trushar Patel More articles by this author Greg Hruby More articles by this author Matt Woznitzer More articles by this author Mitchell C. Benson More articles by this author James Mckiernan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...