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Incidence and predictors of understaging in patients with clinical T 1 urothelial carcinoma undergoing radical cystectomy
Author(s) -
Ark Jacob T.,
Keegan Kirk A.,
Barocas Daniel A.,
Morgan Todd M.,
Resnick Matthew J.,
You Chaochen,
Cookson Michael S.,
Penson David F.,
Davis Rodney,
Clark Peter E.,
Smith Joseph A.,
Chang Sam S.
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12245
Subject(s) - cystectomy , medicine , bladder cancer , confidence interval , odds ratio , incidence (geometry) , urology , pathological , cumulative incidence , radiology , cancer , cohort , physics , optics
Objective 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 A pril 2000 to J uly 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 .Results 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.Conclusions 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 .