May, Matthias and Bastian, Patrick J. and Brookman-May, Sabine and Burger, Maximilian and Bolenz, Christian and Trojan, Lutz and Michel, Maurice S. and Herrmann, Edwin and Wuelfing, Christian and Tiemann, Arne and Mueller, Stefan C. and Ellinger, Joerg and Buchner, Alexander and Stief, Christian G. and Tilki, Derya and Wieland, Wolf F. and Gilfrich, Christian and Hoefner, Thomas and Hohenfellner, Markus and Haferkamp, Axel and Roigas, Jan and Zacharias, Mario and Gunia, Sven and Fritsche, Hans-Martin (2011) Pathological upstaging detected in radical cystectomy procedures is associated with a significantly worse tumour-specific survival rate for patients with clinical T1 urothelial carcinoma of the urinary bladder. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY, 45 (4). pp. 251-257. ISSN 0036-5599,
Full text not available from this repository. (Request a copy)Abstract
Objective. Due to their variable oncological course, clinical stage T1 (cT1) urothelial carcinomas of the bladder (UCBs) are the subject of controversial discussion with regard to indication for radical cystectomy (RC). This study aimed to evaluate the frequency and prognosis of upstaging in patients undergoing RC due to UCB. Material and methods. Clinical and pathological records of 607 patients, having undergone RC for treatment of UCB in cT1N0M0, were summarized in a multi-institutional database. Cancer-specific survival (CSS) and overall survival (OS) rates were calculated. A multivariable prognostic model predicting the possibility of an upstaging in RC specimens was developed based on clinical information. Results. In 210 patients (35%) an upstaging (> pT1 and/or pN+) was detected in the RC specimen. Five- year CSS was 86%, 78%, 60% and 34%, respectively, for tumour stages < pT2N0 (n = 397), pT2N0 (n = 78), > pT2N0 (n = 63) and pN+ (n = 69) (p < 0.001). In a multivariable Cox regression model, pN stage, pT stage and lymphovascular invasion (LVI) revealed an independent influence on CSS (OS: pN, pT, age). An upstaging of cT1 tumours was enhanced by the criteria of G3 tumour grading and absent Tis in the transurethral resection of the bladder (TURB) specimen. Detection of LVI in RC specimens was also independently associated with an upstaging and, therefore, is recommended as a relevant prognostic parameter for the histopathological evaluation of TURB specimens. Conclusions. More than one-third of patients with cT1 tumours had an upstaging that was associated with significant prognosis deterioration. Further valid markers are required for an early identification of these patients. LVI represents such a criterion and, therefore, should be evaluated in prospectively designed trials with accurate histopathological assessment of TURB specimens.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | LYMPHOVASCULAR INVASION; CANCER; SPECIMENS; RESECTION; Bladder cancer; clinical tumour stage T1; lymphovascular invasion; prognosis; radical cystectomy; upstaging; urothelial carcinoma |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 02 Jun 2020 07:55 |
| Last Modified: | 02 Jun 2020 07:55 |
| URI: | https://pred.uni-regensburg.de/id/eprint/20362 |
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