Pathological staging of muscle invasive bladder cancer: is substaging of pT2 tumors really necessary?

Tokgöz, Hüsnü; Türkölmez, Kadír; Reşorlu, Berkan; Köse, Kenan; Tulunay, Özden; Bedük, Yaşar

doi:10.1590/s1677-55382007000600005

Cited by 14 publications

(6 citation statements)

References 17 publications

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“…Notwithstanding, in the present analysis, we focused on risk factors and outcomes in a homogenous single‐centre series of patients with pT2 UCB treated uniformly with RC and ePLND. There were significant differences in survival depending on the depth of muscle‐invasion in LN‐negative pT2 UCB [4,6]. Thus, the present data are supportive of the concept of substratification in LN‐negative pT2 classified UCB, which has been retained in the new TNM staging system [8].…”

Section: Discussionsupporting

confidence: 79%

“…The present study has some limitations inherent in any retrospective analysis that should be considered. First, the sample size of 64 LN‐negative patients and the median overall follow‐up time of 28 months is moderate but still larger than previous single‐centre studies [4,17].…”

Section: Discussionmentioning

confidence: 91%

“…Recently, the prognostic significance of this substratification in LN‐negative pT2 disease has been controversially discussed as possibly not being as significant an independent prognostic indicator as the presence of LN involvement at RC. Further, these studies have concluded that future revisions of the staging system of the AJCC might consolidate the two substages [4,5].…”

Section: Discussionmentioning

confidence: 99%

“… inclusion of patients with non‐UCB components, i.e. SCCs; unknown number of retrieved LNs at RC and unknown extent of PLND; inclusion of patients undergoing neoadjuvant chemotherapy [4–7]. …”

Section: Discussionmentioning

confidence: 99%

“…However, recently the prognostic significance of the substratification of LN‐negative pT2 UCB has been challenged by the suggestion that it may not have a substantial independent prognostic significance when compared with positive LN involvement at RC. However, these studies have been limited owing to the unknown extent of pelvic lymphadenectomy (PLND) and number of retrieved LNs at RC as well as the inclusion of patients with squamous cell carcinoma (SCC) or undergoing neoadjuvant chemotherapy [4–6].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the new American Joint Committee on Cancer substratification in node‐negative pT2 urothelial carcinoma of the bladder: analysis of patient outcomes in a contemporary series

et al. 2010

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patients with pT2b UCB had LN-positive disease ( P = 0.02).• The median (range) number of LNs removed in LN-positive disease was 18 (11-30) and in LN-negative disease was 20 (4-38) ( P = 0.52).• In LN-negative disease, actuarial 5-year RFS was 85.9% in patients with pT2a UCB vs 37.5% in those with pT2b UCB ( P < 0.001). Actuarial 5-year CSS was 84.8% in patients with LN-negative pT2a UCB vs 59.6% in patients with LN-negative pT2b UCB ( P = 0.01).• In Cox regression analysis, pT2 substratification was the only independent risk factor of recurrence and cancer-specific death ( P < 0.001 and P = 0.008). CONCLUSIONS• In this contemporary series of patients undergoing RC with ePLND, there was a significant difference in RFS and CSS between LN-negative pT2a and pT2b UCB, and pT2 substratification was the only risk factor of recurrence and cancer-specific death.• These data are supportive of the current concept of substratification in LN-negative pT2 UCB. KEYWORDSlymph node metastasis, pelvic lymphadenectomy, muscle-invasive, urothelial carcinoma of the bladder, substratification, survival What's known on the subject? and What does the study add?The prognostic value of pathological substratification in lymph node-negative pT2 urothelial carcinoma of the bladder based on tumour depth has been controversially discussed in recent studies. In 1997, the AJCC and UICC modified the TNM staging system in bladder cancer providing a new substratification in pT2 bladder cancer based on a previous study of Jewett in 1952 reporting a worse prognosis for patients with deep muscle invasion compared to those with superficial muscle invasion. Recently, this prognostic significance has been considered of minor importance compared to significance of lymph node tumor involvement. Thus, many of these studies concluded that future revisions of the TNM staging system should consolidate both substages. However, these studies were hampered by the inclusion of patients with non-urothelial carcinoma components, unknown number of retrieved lymph nodes, unknown extent of pelvic lymphadenectomy, and inclusion of patients undergoing neoadjuvant chemotherapy.This study addresses specifically the prognostic significance of pT2 substaging in urothelial cancer in a contemporary, consecutive series of patients treated with radical cystectomy. All patients had pure urothelial cell carcinoma, and underwent an extended lymphadenectomy approach. The number of retrieved lymph nodes was recorded. There was a significant difference in survival in patients with lymph-node negative pT2a vs. pT2b disease. Therefore, this study supports the prognostic value of the current substratification in pT2 urothelial carcinoma of the bladder.Study Type -Prognosis (case series) Level of Evidence 4 OBJECTIVE• To determine whether there is a difference in survival in patients with node-negative pT2a vs pT2b urothelial carcinoma of the bladder (UBC), as recent studies suggest that the new American Joint Committee on Cancer substratification may not have prognostic significance. P...

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%