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Prognostic pathological factors in radical cystectomy after neoadjuvant chemotherapy
Author(s) -
Brimo Fadi,
Downes Michelle R,
Jamaspishvili Tamara,
Berman David,
Barkan Guliz A,
Athanazio Daniel,
Abro Schuharazad,
Visram Kash,
Yilmaz Asli,
Solanki Shraddha,
Hahn Elan,
Siemens Robert,
Kassouf Wassim,
Trpkov Kiril
Publication year - 2018
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13654
Subject(s) - cystectomy , lymphovascular invasion , medicine , stage (stratigraphy) , stromal cell , bladder cancer , oncology , carcinoma , chemotherapy , pathological , cancer , pathology , urology , gastroenterology , metastasis , biology , paleontology
Aims We undertook a systematic evaluation of the prognostic value of numerous histological factors in 165 radical cystectomies (RCs) of patients with invasive urothelial carcinoma (UC) who underwent surgery after neoadjuvant chemotherapy (NAC). Methods and Results Tumour regression grade (TRG) and therapy‐related stromal and epithelial changes were also recorded. Locally advanced disease (≥pT2 and/or pN+) was present in 64% of patients, 22% had no evidence of residual carcinoma (pT0 + pN0), and 28% had no evidence of residual muscle‐invasive carcinoma (≤pT1 + N0). TRG1, TRG2 and TRG3 were found in 32%, 15% and 50% of patients, respectively. Histological variants of UC were reported in 25% of cases. The most common therapy‐related stromal change was fibroblastic reaction (78%), and the most common epithelial change in residual UC was smudgy and poorly preserved chromatin (28%). Prominent stromal and epithelial changes were noted in 41% and 5% of RCs, respectively. Progression was found in 45% of patients, and cancer‐related deaths occurred in 30%. Multivariate analysis showed that the only independent prognostic parameters for progression were T stage, N stage, lymphovascular invasion, and margin status. Similarly, only T stage, N stage and margin status correlated with cancer‐related deaths. Neither TRG nor any of the stromal‐related or epithelial‐related variables correlated with outcome. Conclusions We confirm that the traditional and routinely reported histological parameters in RC post‐NAC remain the most powerful prognosticators of disease course. The significance of TRG in the bladder remains unconfirmed.