Downstaging to non-invasive urothelial carcinoma is associated with improved outcome following radical cystectomy for patients with cT2 disease

Matthew K. Tollefson, Stephen A. Boorjian, Sara A. Farmer, Igor Frank

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Introduction: Pathologic stage is a critically important prognostic factor after radical cystectomy (RC) that is used to guide the use of secondary therapies. However, the risk of disease recurrence, for patients clinically diagnosed with muscle-invasive tumors who are found not to have muscle-invasive disease at RC are poorly defined. Therefore, we reviewed the long-term outcomes in patients who were downstaged to non-invasive urothelial carcinoma at time of RC. Methods: We identified 1,177 consecutive patients with muscle-invasive urothelial carcinoma of the bladder who underwent radical cystectomy at our institution between 1980 and 1999 without neoadjuvant therapy. Postoperative disease recurrence and survival were estimated using the Kaplan-Meier method and compared using the log rank test. Cox proportional hazard regression models were used to analyze the impact of pathologic stage on survival. Results: Pathologic downstaging to non-muscle invasive disease was identified in 538 (45. 7 %) patients. The 10-year cancer-specific survival was 84. 1, 77. 4, 71. 1 and 58. 5 % for those with pT0, pTis, pT1 and pT2 tumors, respectively. On multivariate analysis, the risk of cancer-specific mortality was significantly decreased for patients with non-muscle invasive disease than those with organ-confined muscle invasion (RR-0. 39; p = 0. 002). There was no difference in disease-specific mortality among patients who had non-invasive (pT0, pTa, or pTis) disease (p = 0. 19). Conclusions: Downstaging from clinical muscle-invasive bladder cancer to non-muscle invasive disease at RC is associated with a significant reduction in cancer-specific mortality. However, even patients with residual non-muscle invasive disease may suffer disease recurrence and require continued surveillance after surgery.

Original languageEnglish (US)
Pages (from-to)795-799
Number of pages5
JournalWorld Journal of Urology
Volume30
Issue number6
DOIs
StatePublished - Dec 2012

Keywords

  • Clinical staging
  • Pathologic staging
  • Risk stratification
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

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