Discrepancy between Clinical and Pathologic Stage: Impact on Prognosis after Radical Cystectomy

Shahrokh F. Shariat, Ganesh S. Palapattu, Pierre I. Karakiewicz, Craig G. Rogers, Amnon Vazina, Patrick J. Bastian, Mark P. Schoenberg, Seth P. Lerner, Arthur I Sagalowsky, Yair Lotan

Research output: Contribution to journalArticle

200 Citations (Scopus)

Abstract

Objectives: We compared clinical and pathologic staging in a large, contemporary, consecutive series of patients who were treated with radical cystectomy and pelvic lymphadenectomy, and determined the effect of stage discrepancy on outcomes. Methods: We collected retrospective data from 778 consecutive patients with bladder transitional cell carcinoma who were treated with radical cystectomy and pelvic lymphadenectomy, and for whom the clinical and pathologic stage were available. Results: Pathologic upstaging occurred in 42% of patients, and pathologic downstaging occurred in 22%. Forty percent of patients with non-muscle-invasive clinical stage had muscle-invasive pathologic stage. Thirty-six percent of patients with organ-confined clinical stage had non-organ-confined pathologic stage (≥pT3N0 or pTanyN-positive). Patients with higher clinical stage were more likely to be upstaged to non-organ-confined disease (p < 0.001). Patients were stratified into three groups: pathologically upstaged, same clinical and pathologic stage, and pathologically downstaged. When adjusted for the effects of standard postoperative features, upstaged patients were at a significantly higher risk of disease recurrence and bladder cancer-specific death than patients who had the same pathologic and clinical stage, who in turn were at significantly higher risk than downstaged patients. This observation remained true within each clinical stage strata. Within each pathologic stage strata, clinical stage did not substratify into different risk groups. Conclusions: Clinical to pathologic stage discrepancy is a relatively common finding after extirpative surgery for bladder cancer. Clinical outcomes after radical cystectomy are largely driven by pathologic stage. Better clinical staging is necessary to improve patient evaluation and management.

Original languageEnglish (US)
Pages (from-to)137-151
Number of pages15
JournalEuropean Urology
Volume51
Issue number1
DOIs
StatePublished - Jan 2007

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Cystectomy
Lymph Node Excision
Urinary Bladder Neoplasms
Transitional Cell Carcinoma
Urinary Bladder
Recurrence
Muscles

Keywords

  • Bladder cancer
  • Cystectomy
  • Recurrence
  • Stage
  • Survival

ASJC Scopus subject areas

  • Urology

Cite this

Shariat, S. F., Palapattu, G. S., Karakiewicz, P. I., Rogers, C. G., Vazina, A., Bastian, P. J., ... Lotan, Y. (2007). Discrepancy between Clinical and Pathologic Stage: Impact on Prognosis after Radical Cystectomy. European Urology, 51(1), 137-151. https://doi.org/10.1016/j.eururo.2006.05.021

Discrepancy between Clinical and Pathologic Stage : Impact on Prognosis after Radical Cystectomy. / Shariat, Shahrokh F.; Palapattu, Ganesh S.; Karakiewicz, Pierre I.; Rogers, Craig G.; Vazina, Amnon; Bastian, Patrick J.; Schoenberg, Mark P.; Lerner, Seth P.; Sagalowsky, Arthur I; Lotan, Yair.

In: European Urology, Vol. 51, No. 1, 01.2007, p. 137-151.

Research output: Contribution to journalArticle

Shariat, SF, Palapattu, GS, Karakiewicz, PI, Rogers, CG, Vazina, A, Bastian, PJ, Schoenberg, MP, Lerner, SP, Sagalowsky, AI & Lotan, Y 2007, 'Discrepancy between Clinical and Pathologic Stage: Impact on Prognosis after Radical Cystectomy', European Urology, vol. 51, no. 1, pp. 137-151. https://doi.org/10.1016/j.eururo.2006.05.021
Shariat SF, Palapattu GS, Karakiewicz PI, Rogers CG, Vazina A, Bastian PJ et al. Discrepancy between Clinical and Pathologic Stage: Impact on Prognosis after Radical Cystectomy. European Urology. 2007 Jan;51(1):137-151. https://doi.org/10.1016/j.eururo.2006.05.021
Shariat, Shahrokh F. ; Palapattu, Ganesh S. ; Karakiewicz, Pierre I. ; Rogers, Craig G. ; Vazina, Amnon ; Bastian, Patrick J. ; Schoenberg, Mark P. ; Lerner, Seth P. ; Sagalowsky, Arthur I ; Lotan, Yair. / Discrepancy between Clinical and Pathologic Stage : Impact on Prognosis after Radical Cystectomy. In: European Urology. 2007 ; Vol. 51, No. 1. pp. 137-151.
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abstract = "Objectives: We compared clinical and pathologic staging in a large, contemporary, consecutive series of patients who were treated with radical cystectomy and pelvic lymphadenectomy, and determined the effect of stage discrepancy on outcomes. Methods: We collected retrospective data from 778 consecutive patients with bladder transitional cell carcinoma who were treated with radical cystectomy and pelvic lymphadenectomy, and for whom the clinical and pathologic stage were available. Results: Pathologic upstaging occurred in 42{\%} of patients, and pathologic downstaging occurred in 22{\%}. Forty percent of patients with non-muscle-invasive clinical stage had muscle-invasive pathologic stage. Thirty-six percent of patients with organ-confined clinical stage had non-organ-confined pathologic stage (≥pT3N0 or pTanyN-positive). Patients with higher clinical stage were more likely to be upstaged to non-organ-confined disease (p < 0.001). Patients were stratified into three groups: pathologically upstaged, same clinical and pathologic stage, and pathologically downstaged. When adjusted for the effects of standard postoperative features, upstaged patients were at a significantly higher risk of disease recurrence and bladder cancer-specific death than patients who had the same pathologic and clinical stage, who in turn were at significantly higher risk than downstaged patients. This observation remained true within each clinical stage strata. Within each pathologic stage strata, clinical stage did not substratify into different risk groups. Conclusions: Clinical to pathologic stage discrepancy is a relatively common finding after extirpative surgery for bladder cancer. Clinical outcomes after radical cystectomy are largely driven by pathologic stage. Better clinical staging is necessary to improve patient evaluation and management.",
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AU - Rogers, Craig G.

AU - Vazina, Amnon

AU - Bastian, Patrick J.

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AU - Sagalowsky, Arthur I

AU - Lotan, Yair

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N2 - Objectives: We compared clinical and pathologic staging in a large, contemporary, consecutive series of patients who were treated with radical cystectomy and pelvic lymphadenectomy, and determined the effect of stage discrepancy on outcomes. Methods: We collected retrospective data from 778 consecutive patients with bladder transitional cell carcinoma who were treated with radical cystectomy and pelvic lymphadenectomy, and for whom the clinical and pathologic stage were available. Results: Pathologic upstaging occurred in 42% of patients, and pathologic downstaging occurred in 22%. Forty percent of patients with non-muscle-invasive clinical stage had muscle-invasive pathologic stage. Thirty-six percent of patients with organ-confined clinical stage had non-organ-confined pathologic stage (≥pT3N0 or pTanyN-positive). Patients with higher clinical stage were more likely to be upstaged to non-organ-confined disease (p < 0.001). Patients were stratified into three groups: pathologically upstaged, same clinical and pathologic stage, and pathologically downstaged. When adjusted for the effects of standard postoperative features, upstaged patients were at a significantly higher risk of disease recurrence and bladder cancer-specific death than patients who had the same pathologic and clinical stage, who in turn were at significantly higher risk than downstaged patients. This observation remained true within each clinical stage strata. Within each pathologic stage strata, clinical stage did not substratify into different risk groups. Conclusions: Clinical to pathologic stage discrepancy is a relatively common finding after extirpative surgery for bladder cancer. Clinical outcomes after radical cystectomy are largely driven by pathologic stage. Better clinical staging is necessary to improve patient evaluation and management.

AB - Objectives: We compared clinical and pathologic staging in a large, contemporary, consecutive series of patients who were treated with radical cystectomy and pelvic lymphadenectomy, and determined the effect of stage discrepancy on outcomes. Methods: We collected retrospective data from 778 consecutive patients with bladder transitional cell carcinoma who were treated with radical cystectomy and pelvic lymphadenectomy, and for whom the clinical and pathologic stage were available. Results: Pathologic upstaging occurred in 42% of patients, and pathologic downstaging occurred in 22%. Forty percent of patients with non-muscle-invasive clinical stage had muscle-invasive pathologic stage. Thirty-six percent of patients with organ-confined clinical stage had non-organ-confined pathologic stage (≥pT3N0 or pTanyN-positive). Patients with higher clinical stage were more likely to be upstaged to non-organ-confined disease (p < 0.001). Patients were stratified into three groups: pathologically upstaged, same clinical and pathologic stage, and pathologically downstaged. When adjusted for the effects of standard postoperative features, upstaged patients were at a significantly higher risk of disease recurrence and bladder cancer-specific death than patients who had the same pathologic and clinical stage, who in turn were at significantly higher risk than downstaged patients. This observation remained true within each clinical stage strata. Within each pathologic stage strata, clinical stage did not substratify into different risk groups. Conclusions: Clinical to pathologic stage discrepancy is a relatively common finding after extirpative surgery for bladder cancer. Clinical outcomes after radical cystectomy are largely driven by pathologic stage. Better clinical staging is necessary to improve patient evaluation and management.

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KW - Recurrence

KW - Stage

KW - Survival

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