High-grade T1 Urothelial Carcinoma Research Articles

Bladder Perforation during Transurethral Resection of Bladder Tumor Is Not an Innocent Accident: Literature Review Based on a Clinical Case Experience

Urothelial Carcinoma (UC) is one of the most frequent cancers worldwide. Transurethral Resection of Bladder Tumor (TURBT) is a standard treatment in the disease’s early stages, with bladder perforation being a possible and classical complication. However, extravesical tumor seeding resulting from perforation is a rare phenomenon. We hereby report the case of a 76-year-old man with a history of smoking diagnosed with high-grade T1 urothelial carcinoma. TURBT was performed and bladder perforation occurred during the procedure. Radical cystectomy after neoadjuvant chemotherapy failed to reveal an invasive tumor. However, the patient experienced peritoneal recurrence with liver metastasis 3 years following the operation. This case left physician wondering whether the bladder perforation and the resulting tumor seeding are the cause behind the late peritoneal recurrence of an early-stage urothelial carcinoma.

Development and Validation of a Nomogram to Predict Lymph Node Metastasis in Patients With T1 High-Grade Urothelial Carcinoma of the Bladder.

PurposeThis study aims to develop and validate a nomogram to predict lymph node (LN) metastasis preoperatively in patients with T1 high-grade urothelial carcinoma.MethodsWe retrospectively evaluated the data of 2,689 patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC) and bilateral lymphadenectomy in two medical centers. Eventually, 412 patients with T1 high-grade urothelial carcinoma were enrolled in the primary cohort to develop a prognostic nomogram designed to predict LN status. An independent validation cohort (containing 783 consecutive patients during the same period) was subjected to validate the predicting model. Binary regression analysis was used to develop the predicting nomogram. We assessed the performance of the nomogram concerning its clinical usefulness, calibration, and discrimination.ResultsOverall, 69 (16.75%), and 135 (17.24%) patients had LN metastasis in the primary cohort and external validation cohort, respectively. The final nomogram included information on tumor number, tumor size, lymphovascular invasion (LVI), fibrinogen, and monocyte-to-lymphocyte ratio (MLR). The nomogram showed good predictive accuracy and calibration with a concordance index in the primary cohort of 0.853. The application of the nomogram in the external validation cohort still gave good discrimination (C-index, 0.845) and good calibration. The analysis of the decision curve shows that the nomogram has clinical application value.ConclusionThe nomogram that incorporated the tumor number, tumor size, LVI, fibrinogen, and MLR showed favorable predictive accuracy for LN metastasis. It may be conveniently used to predict LN metastasis in patients with T1 high-grade urothelial carcinoma and be helpful in guiding treatment decisions.

High-grade T1 Urothelial Carcinoma: Where Do We Stand?

Bladder cancer is a deadly and common malignancy, with 24% of new cases presenting as T1 disease. High-grade T1 in particular represents a difficult entity to treat due to its clinical variability and known risks of recurrence, progression, and cancer-specific mortality. The differences in guidelines from major urologic organizations underscore this variability, and the past year has seen another BCG shortage, further complicating management. Advances have been made in the molecular and genomic characterization of high-grade T1, and new clinical trials are available to investigate alternative therapies. In this review, we summarize the variations in guidelines, alternatives to BCG, emerging molecular and genomic discoveries, and recent clinical trials. Adherence to guidelines for non-muscle-invasive bladder cancer in the community among practicing urologists remains low, in part due to the variations in available guidelines. In the era of a BCG shortage, decreased dosing schedules and alternative intravesical options are increasingly being used. New biomarkers are being discovered to better risk-stratify patients, with future therapies aimed at targeting aggressive disease. HGT1 urothelial carcinoma remains a highly variable and aggressive disease, but we are making significant progress in better characterizing the clinical and molecular factors that influence recurrence and progression, to better guide management.

CD163+ macrophages predict a poor prognosis in patients with primary T1 high-grade urothelial carcinoma of the bladder.

Macrophages are a major cell type that can infiltrate solid tumors and exhibit distinct phenotypes in different tumor microenvironments. This study investigates the prognostic value of tumor-infiltrated CD163+ macrophages in patients with T1 high-grade (T1HG) bladder cancer. CD163+ macrophages were assessed by immunohistochemistry in 94 T1HG bladder cancer samples. Kaplan-Meier analyses and Cox proportional hazards' regression models were applied to evaluate recurrence-free survival, progression-free survival and disease-specific survival. With a median follow-up of 60months, 37 (39.4%) patients experienced disease recurrence, 14 (14.9%) progression, 11 (11.7%) disease-specific mortality. High CD163+ macrophages were associated with higher risk of disease recurrence and progression (P < 0.05, for both). In multivariate Cox proportional hazards regression analysis, high CD163+ macrophages were a significant negative predictor of recurrence-free survival, progression-free survival and disease-specific survival (P < 0.05 for all). CD163+ macrophages are a poor prognostic factor in T1HG bladder cancer. This finding provide the ground for further testing it in predicting the outcome of this challenging disease.

Management of High-grade T1 Urothelial Carcinoma.

The optimal management of high-grade T1 (HGT1) urothelial carcinoma (UC) is complex given its high rate of recurrence, progression, and cancer-specific mortality as well as its clinical variability. Our current treatment paradigm has been supplemented by recent data describing the expanding options for salvage intravesical therapy, bladder preservation, and the promising role of molecular epidemiology. In the current review, we attempt to summarize and critically analyze these studies. Evidence describing new intravesical therapies has demonstrated an adequate safety profile and some efficacy in BCG-unresponsive patients who desire bladder preservation. However, response rates are still poor in this high-risk patient population, and it is important to keep these data in perspective when counseling patients. Concomitantly, the continued molecular characterization of non-muscle-invasive bladder cancer may suggest potential therapeutic targets as well as predictors of treatment response in the future. The integration of new intravesical therapies and molecular data into the current treatment paradigm for HGT1 urothelial carcinoma will be critical to improving oncologic outcomes in this particularly high-risk population.

Recurrence and upstaging rates of T1 high-grade urothelial carcinoma of the bladder on repeat resection in a Canadian, resource-limited, healthcare system.

Non-muscle-invasive bladder cancer is the most expensive malignancy to treat. Current Canadian guidelines recommend repeat transurethral resection of bladder tumour (TURBT) within six weeks after initial resection of T1 high-grade (T1HG) urothelial carcinoma, prior to initiation of intravesical bacillus Calmette-Guerin treatment. This is a burden on operating room usage and adds further cost and risk of complications. Internationally, major cancer centres report significant rates of recurrence and upstaging on repeat resection, however, minimal Canadian data is available. We aimed to determine the rate of recurrence and upstaging in a resource-limited, Canadian healthcare system. A retrospective review of patients receiving TURBT between November 2009 and November 2014 was performed. Patients were included if they had all three of the following: a pathological diagnosis of T1HG, adequate muscularis propria present in the specimen, and a repeat resection. We reviewed 3166 patients who underwent TURBT and found 173 to meet our inclusion criteria. The overall recurrence and upstaging rates were 57.2% and 9.2%, respectively. Tumour recurrence and upstaging occurred more often in patients who had repeat resection after 12-24 weeks compared to those patients whose repeat resection occurred within 12 weeks. Although recurrence rates are similar, we have found upstaging rates to be three- to four-fold lower than those previously reported. Despite this, one in 10 patients will be upstaged, justifying use of this resource within our healthcare system. Finally, timely repeat resection, within 12 weeks appears to be associated with preventing disease progression.

MP15-11 BLADDER PRESERVATION IN ELDERLY PATIENTS HAVING NON-MUSCLE INVASIVE HIGH GRADE RECURRENT TA, T1 UROTHELIAL CARCINOMA WITH GEMCITABINE, PACLITAXEL, DOXORUBICIN AND RADIOTHERAPY: SURVIVAL AND QUALITY OF LIFE.

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2017MP15-11 BLADDER PRESERVATION IN ELDERLY PATIENTS HAVING NON-MUSCLE INVASIVE HIGH GRADE RECURRENT TA, T1 UROTHELIAL CARCINOMA WITH GEMCITABINE, PACLITAXEL, DOXORUBICIN AND RADIOTHERAPY: SURVIVAL AND QUALITY OF LIFE. Mohamed Wishahi, Hossam Elganzoury, and Amr Elkhouly Mohamed WishahiMohamed Wishahi More articles by this author , Hossam ElganzouryHossam Elganzoury More articles by this author , and Amr ElkhoulyAmr Elkhouly More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.496AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES INTRODUCTION: Non-muscle invasive carcinoma of the bladder (NMICB) of high grade Ta, T1 tumor that recurred after Intavesical BCG, had a high incidence of tumor progression. Elderly patient are often refuse radical cystectomy (RC) and urinary diversion, to keep their body image and quality of life. OBJECTIVES: To estimate the response rate of gemcitabine, paclitaxel, doxorubicin combined with radiotherapy aiming at bladder preservation in elderly patients =75 years old with recurrent high grade T1 urothelial carcinoma (UC). We conducted a prospective study to evaluate the multimodality treatment for bladder preservation in elderly patients. Overall survival, disease free survival, and quality of life were estimated and correlated with a matched arm of (RC). METHODS In a prospective study, we included 105 elderly patients with NMICB, 57 patients had high grade T1 tumor, 48 patients with high grade Ta, both TA and T1 were NMICB, patients were recurrent after complete course of intavesical BCG, patients asked for bladder preservation. The multimodality treatment arm was compared with matched arm of 60 patients treatment with RC. Follow up was up to 3 - 4years. Overall survival (OS) and disease free survival (DFS) was calculated using Kaplan-Mayer and Cox proportional hazards model and compared to a second arm of 30 patients with similar criteria that had RC. Inclusion criteria in both arms were non-metastatic NMICB, no prior chemotherapy, glomerular filtration rate <60?mL/min. Gemcitabine (900?mg/m(2)), paclitaxel (135?mg/m(2)), and doxorubicin (40?mg/m(2)) were administered on day 1 of each 14-day cycle. Pegfilgrastim was given with every cycle on either day 1 or day. low dose radiotherapy were given following chemotherapy. RESULTS Median age was 77 years (range 75-84). All patients had complete responses. Grade 3 and 4 nonhematologic toxicities were fatigue and mucositis (14% each). There were 12 episodes of neutropenic fever, no treatment-related deaths. Median overall survival was 28.5 months CONCLUSIONS Results of combination of gemcitabine, paclitaxel, and doxorubicin as first-line chemotherapy combination with radiotherapy for elderly patients with recurrent high grade Ta, T1 NMICB of UC in elderly patients =75 years old. Were compatible with RC. Bladder preservation with first line chemoradiothery would be considered as an alternative to RC in elderly patients as it offers better quality of life © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e174-e175 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Mohamed Wishahi More articles by this author Hossam Elganzoury More articles by this author Amr Elkhouly More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Association between the metabolic syndrome and T1 high grade urothelial carcinoma of the bladder

Objective To summarize the relationship between metabolic syndrome(MS), its components and T1 stage with high grade urothelial carcinoma (HGUC) of the Bladder. Methods The clinical data of 200 patients with T1 high grade bladder cancer who were admitted to our hospital from January 2010 to June 2014 were retrospectively analyzed, including 155 males and 45 females. Ages were 24 to 86 years old, average 66 years old. Based on the history or blood glucose levels, patients were divided into diabetic group (n = 41) (20.5%) and non diabetes group 159 cases (79.5%); According to the body mass index (BMI) were divided into obese group (≥25 kg / m2) of 98 cases (49.0%) and non obese group (< 25 kg / m2) of 102 cases (51.0%). According to the blood pressure level, 71 cases (35.5%) were divided into hypertension group and 129 cases of non hypertension group (64.5%). MS and its components and the relationship between the recurrence and progress of bladder cancer were analyzed. The Kaplan Meier method was used to assess MS and its components division of tumor progression free survival (progress-free survival, PFS) and recurrence free survival (recurrence-free survival, RFS) influence. Cox regression model of multi factor analysis were used to evaluate the PFS and RFs of MS and its components with bladder cancer. Results Of the 200 cases, 16 cases (8.0%) were MS. Tumor recurrence occurred in 121 cases (60.5%), and 84 patients (42.0%) were in progress. Diabetes and non diabetes groups the average RFs were 21.7 and 29.3 months respectively, and the difference was statistically significant (χ2=10.115, P=0.001); The median PFS were 32.8 and 39.8 months respectively, the difference has statistical significance (χ2=14.760, P<0.001). Obese group and non obese group average RFs were 34.7 and 42.0 months respectively, and the difference were statistically significant (χ2=16.077, P<0.001); The median PFS were 22.8 and 32.6 months respectively, the difference was statistically significant (χ2=16.174, P<0.001). The average RFS of MS group and non MS group were 21.5 and 28.4 months respectively, the difference was statistically significant (χ2=5.429, P=0.02); the average PFS was 35.1 and 38.7 months respectively, and the difference was statistically significant (χ2=3.854, P<0.05). Cox multivariate survival analysis showed that diabetes and obesity can increase the risk of recurrence and progression of T1 advanced stage bladder cancer (HR=1.792, P=0.013, HR=2.498, P<0.001; HR=0.559, P<0.001; HR=0.492, P<0.001). Conclusions Diabetes mellitus and obesity are high risk factors for the recurrence and progression of T1 advanced stage bladder cancer, but MS is not related to the prognosis of T1 patients with advanced bladder cancer. Key words: Metabolic syndrome; Urothelial carcinoma; Diabetes mellitus; Hypertension; Obesity

V11-13 LAPAROENDOSCOPIC SINGLE SITE NEPHROURETERECTOMY: TECHNIQUE &amp; INITIAL EXPERIENCE

You have accessJournal of UrologyAdrenal/Single Port Surgery/LESS/NOTES1 Apr 2015V11-13 LAPAROENDOSCOPIC SINGLE SITE NEPHROURETERECTOMY: TECHNIQUE & INITIAL EXPERIENCE Jenna She, Alison Rutledge, and Albert Tiu Jenna SheJenna She More articles by this author , Alison RutledgeAlison Rutledge More articles by this author , and Albert TiuAlbert Tiu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2611AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Open radical nephroureterectomy remains the “gold standard” treatment for upper urinary tract urothelial carcinoma. Laparoendoscopic single site (LESS) nephroureterectomy has raised significant interest worldwide to reduce morbidity and scarring associated with conventional laparoscopy. The objective of this study is to investigate the techniques, safety and feasibilities of LESS nephroureterecomy for upper urinary tract urothelial carcinoma. METHODS We retrospectively reviewed a prospectively maintained database to identify patients who underwent laparoendoscopic single site nephroureterectomy for upper urinary tract urothelial carcinoma. Perioperative data were recorded along with functional and oncological outcomes. Our technique was performed using the GelPOINT device (Applied Medical, Rancho Santa Margarita, CA, USA) through a peri-umbilical incision. We placed four ports into the GelPOINT (3x10mm and 1x12mm). Our management of the distal ureter and badder cuff mimicked those of the open approach in all cases. The bladder cuff was dissected circumferentially around the ureteric orifice. The bladder defect was closed with continuous running barbed V-Loc (Covidien, Dublin, Ireland). RESULTS A total of three patients were identified (2 female, 1 male) from July 2013 to July 2014. The mean age was 66 years old (59-69 and mean BMI was 26. There were two left sided upper urinary tract tumour and one right sided upper urinary tract tumour. Of these tumours two were located in the upper ureter and one was in the mid ureter. The mean pre-operative and post-operative creatinine was 90 umol/L and 110 umol/L respectively. The mean estimated blood loss was 266 mL and the mean total operative time was 210 minutes. The mean length of hospital stay was 3 days. None of the patients were converted to open surgery. There was one post operative complication of urinary tract infection. None of the patients required blood transfusion. The final histology confirmed one high grade Ta urothelial carcinoma and two high grade T1 urothelial carcinoma. Of the two high grade T1, one has concurrent carcinoma in-situ. There was no positive surgical margin. At the median follow up of 6 months there was no local or distal recurrences CONCLUSIONS Our initial LESS nephroureterectomy experience is comparable to other minimal invasive & open series. There is a potential in the future for long term follow up analysis across multi-institutions. Significant improvements are required to address the current challenges of LESS. Careful selection of patients for LESS nephroureterectomy is crucial © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e910-e911 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jenna She More articles by this author Alison Rutledge More articles by this author Albert Tiu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Measuring the dimension of invasive component in pT1 urothelial carcinoma in transurethral resection specimens can predict time to recurrence

Recurrences of nonmuscle-invasive urothelial bladder cancer are very common following resection. Predictive histopathologic variables in transurethral resection of bladder tumor (TURBT) specimens are of particular importance especially in determining the behavior of lamina propria-invasive tumors (high grade T1 stage). A total of 110 patients who underwent TURBT for urothelial carcinoma (1997-2005) from a single institution were retrospectively reviewed. Amount of tumor invasion by urothelial carcinoma was assessed in terms of percentage, focality (focal vs multifocal), and dimension (DI, aggregate length of invasion). Of 110 patients, 39 (35%) were found to have invasive high-grade urothelial carcinoma, including 9 females. Mean age was 70 years (range, 56-94 years). Twenty-three patients with high-grade T1 urothelial carcinoma had available follow-up information. Recurrence rate in these 23 patients was 96% (22/23). Nearly all of the recurences (221/22, 95%) occurred within 1 year of the initial TURBT. There was an inverse correlation of DI with time to recurrence (P < .05; correlation coefficient, -0.47). Urothelial carcinoma with a greater DI (>0.5 cm) had a mean time to recurrence of less than 6 months. Percentage of tumor invasion and focality was not associated with recurrence. The aggregate length of invasion may be a prognostic variable for high-risk nonmuscle-invasive bladder cancer. Measuring "aggregate length of invasive tumor," if further validated in larger studies, could provide a practical alternative in substaging pT1 tumors in TURBT specimens.

929 Obesity heads to worse outcomes in patients with T1 high grade urothelial carcinoma of the bladder

929 Obesity heads to worse outcomes in patients with T1 high grade urothelial carcinoma of the bladder

752 Female gender is associated with higher risk of disease recurrence in patients with primary T1 high grade urothelial carcinoma of the bladder

752 Female gender is associated with higher risk of disease recurrence in patients with primary T1 high grade urothelial carcinoma of the bladder

Obesity is Associated with Worse Outcomes in Patients with T1 High Grade Urothelial Carcinoma of the Bladder

To our knowledge the impact of body mass index on oncologic outcomes in nonmuscle invasive bladder cancer has not been evaluated. We hypothesized that higher body mass index is associated with worse outcomes in patients with clinical primary T1 high grade urothelial carcinoma of the bladder. We retrospectively analyzed data from 892 patients with primary nonmuscle invasive bladder cancer from 7 centers. Patients were treated with transurethral resection of the bladder with or without intravesical therapy. Body mass index was analyzed as a continuous and a categorical variable (nonobese-body mass index less than 30 kg/m(2) vs obese-body mass index 30 kg/m(2) or greater). Disease progression was defined as the development of T2 or higher tumor stage. Median followup was 42.8 months (IQR 56). Of the patients 44.3% were obese and median body mass index was 29.2 kg/m(2) (IQR 8). On univariable analyses higher body mass index and age were associated with an increased risk of disease recurrence, progression, cancer specific mortality and any cause mortality (all p ≤ 0.001). On multivariable analyses that adjusted for the effects of gender, concomitant carcinoma in situ, tumor size, number of tumors and intravesical therapy, higher body mass index and age remained independent predictors of disease recurrence, progression, cancer specific mortality and any cause mortality (all p <0.05). This study was limited by its design (ie lack of data on repeat transurethral resection of the bladder and intravesical therapy protocol). Patients diagnosed with clinical T1 high grade urothelial carcinoma of the bladder who are obese have worse cancer specific outcomes compared to their nonobese counterparts. Further work is needed to improve our understanding of clinical T1 high grade outcomes in the growing population of obese patients.

Laparoscopic repair of iatrogenic bladder perforation during transurethral bladder tumor resection: Case report and literature review

An intraperitoneal bladder perforation occurred during transurethral tumor resection under general anesthesia in a 82 year old woman. The bladder was repaired with a laparoscopic closure and an indwelling urethral catheter. The histopathology revealed T1 high grade urothelial carcinoma. The patient recovered well and was discharged home on postoperative day 7. This case highlights the successful use of laparoscopy in the treatment of a rare urological complication.

Muscle-invasive bladder cancer in a young adult: a case report and a review of the literature.

The peak incidence of bladder cancer (BC) is in the sixth decade of life. Muscle–invasive bladder cancer (MIBC) in young adults is extremely rare. We report a case of MIBC in a 28–year–old smoking male patient. The patient presented with hematuria and flank pain for which he underwent a computerized tomography (CT) scan of the abdomen and pelvis with and without contrast. The CT scan showed a 6 cm mass on the left side of the trigone extending to the left urteric orifice and left hydronephrosis, but no lymphadenopathy was noted. The patient then underwent a left nephrostomy tube placement followed by trans–urethral resection of bladder tumor (TURBT). The tumor involved both ureteric orifices and extended to the prostatic urethra. Complete resection was not feasible. Pathology showed high–grade T1 urothelial carcinoma. CT scan of the chest showed no distant lung metastasis. The patient then elected to undergo radical cystectomy with ileal conduit urinary diversion. Final pathology revealed T2a N0 urothelial carcinoma of the bladder. Our aim is to present our experience and review the literature for the natural history and oncological and quality of life outcomes of urothelial carcinoma of the bladder in young patients.

Female gender is associated with higher risk of disease recurrence in patients with primary T1 high-grade urothelial carcinoma of the bladder

An increasing body of evidence suggests gender differences in the presentation and prognosis of bladder cancer. We aimed to assess the impact of gender on outcomes in patients with primary T1 high-grade (HG) urothelial carcinoma of the bladder (UCB). We retrospectively analysed the data from 916 patients with primary T1HG UCB from 7 tertiary care centres. Patients were treated with transurethral resection of the bladder with or without intravesical instillation therapy (IVT). Univariable and multivariable Cox regression analyses assessed the effect of gender on outcomes. Within a median follow-up of 42.8 months, 365 (39.8 %) patients experienced disease recurrence, 104 (11.4 %) progression, 59 (6.4 %) cancer-specific mortality and 190 (20.7 %) mortality of any cause. Overall, 634 (69.2 %) patients received IVT of which 234 (25.5 %) received BCG therapy. Female gender (n = 190, 20.7 %) was associated with higher risk of disease recurrence (HR:1.359;1.071-1.724, p = 0.012) in all patients and in a subgroup of patients treated with BCG therapy (HR:1.717;1.101-2.677, p = 0.017). There was no difference between genders with regard to disease progression, cancer-specific mortality and any-cause mortality. In multivariable analyses that adjusted for the effects of concomitant carcinoma in situ (CIS), tumour size, number of tumours, and IVT, gender remained an independent predictor for disease recurrence (p = 0.026) when analysed in all patients, but not in the subgroup of BCG treated patients (p = 0.093). In patients with T1HG UCB, female gender is associated with higher risk of disease recurrence, but not with disease progression. This gender disparity may be due to differences in care and/or biology of UCB.

Use of radical cystectomy as initial therapy for the treatment of high-grade T1 urothelial carcinoma of the bladder: A SEER database analysis

ObjectivesHigh-grade T1 (HGT1) bladder cancer represents a heterogeneous disease with an aggressive phenotype. Despite prior reports demonstrating improved cancer-specific mortality (CSM) in patients who receive an early/immediate radical cystectomy (RC), the role of early surgery remains ill-defined. We analyzed the Surveillance Epidemiology and End Results (SEER) database to ascertain the use of RC as an initial therapy for clinical HGT1 bladder cancer. Materials and methodsUsing the SEER database from 2004 through 2007, we identified and stratified patients with clinical HGT1 bladder cancer who underwent RC as initial therapy within 1 year of diagnosis. We used χ2 tests and t-tests to compare characteristics of surgical vs. nonsurgical patients. Cumulative incidence functions and Gray's test for inferences were employed to assess cause-specific mortality outcomes. ResultsFrom 2004 to 2007, 8,467 patients were diagnosed with clinical HGT1 bladder cancer, and 397 (4.7%) patients underwent RC. Patients who underwent RC for clinical HGT1 disease were significantly younger (P < 0.0001) and married (P < 0.0001). Surgical patients also had a significantly improved overall (P = 0.004) and other cause of death (P = 0.0053) survival probabilities yet CSM at 1, 2, and 3 years was not statistically different between the surgical and nonsurgical groups (P = 0.134). ConclusionsIn contrast to the clinically early stage renal and prostate cancers, HGT1 bladder cancer exhibits a higher degree of early progression and potential lethality. Despite routine use of extirpative surgery for T1 lesions of the kidney and prostate, our analysis of the SEER database reveals that definitive surgical therapy is uncommonly employed for HGT1 bladder cancer.

1349 DOES THE PRESENCE OF MUSCULARIS PROPRIA ON BIOPSY AFFECT THE RATE OF UPSTAGING IN T1 BLADDER CANCER

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 ...