Incidence and predictors of understaging in patients with clinical T1 urothelial carcinoma undergoing radical cystectomy
Article first published online: 3 APR 2014
© 2013 The Authors. BJU International © 2013 BJU International
Volume 113, Issue 6, pages 894–899, June 2014
How to Cite
Ark, J. T., Keegan, K. A., Barocas, D. A., Morgan, T. M., Resnick, M. J., You, C., Cookson, M. S., Penson, D. F., Davis, R., Clark, P. E., Smith, J. A. and Chang, S. S. (2014), Incidence and predictors of understaging in patients with clinical T1 urothelial carcinoma undergoing radical cystectomy. BJU International, 113: 894–899. doi: 10.1111/bju.12245
- Issue published online: 6 JUN 2014
- Article first published online: 3 APR 2014
- Accepted manuscript online: 23 MAY 2013 06:47AM EST
- National Institutes of Health, K-12 Paul Calabresi Career Development Award for Clinical Oncology. Grant Number: CA-90625
- Agency for Healthcare Research and Quality. Grant Number: 1R01HS019356
- National Center for Research Resources
- National Center for Advancing Translational Sciences
- National Institutes of Health. Grant Numbers: UL1 RR025744, UL1 RR024975
- urinary bladder neoplasms;
- outcome and process assessment (health care);
- urinary bladder;
- surgical pathology
- To evaluate predictors of understaging in patients with presumed non-muscle-invasive bladder cancer (NMIBC) identified on transurethral resection of bladder tumour (TURBT) who underwent radical cystectomy (RC) with attention to the role of a restaging TURBT.
Patients and Methods
- We retrospectively evaluated 279 consecutive patients with clinically staged T1 (cT1) disease after TURBT who underwent RC at our institution from April 2000 to July 2011.
- In all, 60 of these cT1 patients had undergone a restaging TURBT before RC.
- The primary outcome measure was pathological staging of ≥T2 disease at the time of RC.
- In all, 134 (48.0%) patients were understaged.
- Of the 60 patients who remained cT1 after a restaging TURBT, 28 (46.7%) were understaged.
- Solitary tumour (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.25–0.76, P = 0.004) and fewer prior TURBTs (OR 0.84, 95% CI 0.71–1.00, P = 0.05) were independent risk factors for understaging.
- Despite the overall improvement in staging accuracy linked to restaging TURBTs, the risk of clinical understaging remains high in restaged patients found to have persistent T1 urothelial carcinoma who undergo RC.
- Solitary tumour and fewer prior TURBTs are independent risk factors for being understaged. Incorporating these predictors into preoperative risk stratification may allow for augmented identification of those patients with clinical NMIBC who stand to benefit most from RC.