TY - JOUR
T1 - Multiple Adverse Histological Features Increase the Odds of Under Staging T1 Bladder Cancer
AU - Weizer, Alon Z.
AU - Wasco, Matthew J.
AU - Wang, Rou
AU - Daignault, Stephanie
AU - Lee, Cheryl T.
AU - Shah, Rajal B.
PY - 2009/7
Y1 - 2009/7
N2 - Purpose: The clinical under staging of T1 bladder cancer potentially delays therapy and undermines survival. In this study we evaluated clinicopathological features to aid in the identification of patients with clinical T1 bladder cancer at risk for under staging. Materials and Methods: We identified patients diagnosed with clinical T1 bladder cancer who underwent cystectomy within 4 months. Muscularis propria was present and uninvolved in initial biopsies or patients had a re-staging biopsy with muscle invasion present. Under staging was defined as pT2 or greater, N+ or M+ disease at radical cystectomy. A logistic regression multivariable model was used for the risk of under staging. Overall survival was assessed using the Kaplan-Meier method. Results: Of 95 patients 26 (27%) had under staged disease. Median followup was 24 months. Compared to accurately staged cases under staged cases were more likely to have muscularis mucosae invasion (54% vs 19%, p = 0.001), mixed histology (42% vs 17%, p = 0.02) and urethral involvement (31% vs 10%, p = 0.03). In a multivariable model muscularis mucosae invasion increased the odds of under staging 9-fold (95% CI 1.5-54.5, p = 0.01). The cumulative association of these risk factors increased the odds of under staging 20-fold (95% CI 1.8-217, p = 0.0029). Median overall survival (years) was lower in patients with under staged disease (1.4 vs 10.6, p <0.001), those with muscularis mucosae invasion (2.2 vs 6.5, p = 0.04) and those with urethral involvement (25th percentile 0.8 vs 2.0, p = 0.01). Conclusions: Under staging adversely impacts survival. Muscularis mucosae invasion, urethral involvement and mixed histology cumulatively increase the risk of under staging, and may be valuable in counseling patients regarding early, aggressive intervention.
AB - Purpose: The clinical under staging of T1 bladder cancer potentially delays therapy and undermines survival. In this study we evaluated clinicopathological features to aid in the identification of patients with clinical T1 bladder cancer at risk for under staging. Materials and Methods: We identified patients diagnosed with clinical T1 bladder cancer who underwent cystectomy within 4 months. Muscularis propria was present and uninvolved in initial biopsies or patients had a re-staging biopsy with muscle invasion present. Under staging was defined as pT2 or greater, N+ or M+ disease at radical cystectomy. A logistic regression multivariable model was used for the risk of under staging. Overall survival was assessed using the Kaplan-Meier method. Results: Of 95 patients 26 (27%) had under staged disease. Median followup was 24 months. Compared to accurately staged cases under staged cases were more likely to have muscularis mucosae invasion (54% vs 19%, p = 0.001), mixed histology (42% vs 17%, p = 0.02) and urethral involvement (31% vs 10%, p = 0.03). In a multivariable model muscularis mucosae invasion increased the odds of under staging 9-fold (95% CI 1.5-54.5, p = 0.01). The cumulative association of these risk factors increased the odds of under staging 20-fold (95% CI 1.8-217, p = 0.0029). Median overall survival (years) was lower in patients with under staged disease (1.4 vs 10.6, p <0.001), those with muscularis mucosae invasion (2.2 vs 6.5, p = 0.04) and those with urethral involvement (25th percentile 0.8 vs 2.0, p = 0.01). Conclusions: Under staging adversely impacts survival. Muscularis mucosae invasion, urethral involvement and mixed histology cumulatively increase the risk of under staging, and may be valuable in counseling patients regarding early, aggressive intervention.
KW - cystectomy
KW - pathology
KW - urinary bladder neoplasms
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U2 - 10.1016/j.juro.2009.02.116
DO - 10.1016/j.juro.2009.02.116
M3 - Article
C2 - 19447443
AN - SCOPUS:67349158889
SN - 0022-5347
VL - 182
SP - 59
EP - 65
JO - Journal of Urology
JF - Journal of Urology
IS - 1
ER -