Clinical–Pathologic Stage Discrepancy in Bladder Cancer Patients Treated With Radical Cystectomy: Results From the National Cancer Data Base

Gray, Phillip J.; Lin, Chun Chieh; Jemal, Ahmedin; Shipley, William U.; Fedewa, Stacey A.; Kibel, Adam S.; Rosenberg, Jonathan E.; Kamat, Ashish M.; Virgo, Katherine S.; Blute, Michael L.; Zietman, Anthony L.; Efstathiou, Jason A.

doi:10.1016/j.ijrobp.2014.01.001

Cited by 73 publications

(46 citation statements)

References 33 publications

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“…24 Discrepancies between clinical and pathological staging is a major issue in MIBC with upstaging post-cystectomy occurring in almost 30% to 61% of cases. 16,[25][26][27] One of the strongest risk factors for upstaging is T2-disease. [25][26][27] As 20% to 30% of patients with pT2 disease relapse distantly and the SWOG-8710 trial reported a median 30-month improvement in overall survival with NC in patients with T2-tumours, there is a strong rationale to use NC even in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…16,[25][26][27] One of the strongest risk factors for upstaging is T2-disease. [25][26][27] As 20% to 30% of patients with pT2 disease relapse distantly and the SWOG-8710 trial reported a median 30-month improvement in overall survival with NC in patients with T2-tumours, there is a strong rationale to use NC even in these patients. 6,22 An alternate strategy is to use a risk-stratified approach, in which patients with high-risk features receive NC and lowrisk patients who are upstaged receive adjuvant chemotherapy (AC).…”

Section: Discussionmentioning

confidence: 99%

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Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

Hsu

Black

et al. 2014

CUAJ

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Introduction: Uptake of neoadjuvant chemotherapy (NC) for muscle invasive bladder cancer (MIBC) has been low despite evidence of a survival benefit. The primary aim of this study was to better understand why the rates are low and determine what factors specifically influence the decision to recommend NC for MIBC. Methods: A 31-question survey was emailed between 2009 and 2011 to medical oncologists belonging to the Canadian Association of Genitourinary Medical Oncologists (CAGMO); and to urologists belonging to the Canadian Urologic Oncology Group (CUOG). We gathered data on practice characteristics, referrals for NC, factors influencing NC use, and chemotherapy regimens offered. Responses were summarized using descriptive statistics. Results: In total, 26/30 (87%) medical oncologists and 25/84 (30%) urologists, who were primarily academic, completed the survey. Most clinicians (medical oncologists 96%, urologists 88%) recommended NC for MIBC, because they considered it to be the standard of care, but most medical oncologists saw ≤6 referrals annually. Performance status, presence of comorbidities and renal function were key considerations in offering NC. NC was not offered if performance status ≥2 (medical oncologists 38%, urologists 44%), age >80 (medical oncologists 46%, urologists 39%), or glomerular filtration rate ≤40 mL/min (medical oncologists 81%, urologists 50%). Conclusions: Most academic clinicians in Canada believe that cisplatin-based combination NC is the standard of care for MIBC and recommend it for patients with adequate performance status and renal function. Using a multidisciplinary approach to treat this disease may be one strategy to increase referral rates for NC and uptake of NC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

Hsu

Black

et al. 2014

CUAJ

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“…It is well established that preoperative staging is inaccurate in approximately 50 % of patients undergoing RC [14][15][16]. The NCCN guidelines recommend imaging with either contrast-enhanced CT scanning or MR Urography [11]; however, the sensitivity of these studies ranges from 60.0 to 76.4 % [17,18].…”

Section: Discussionmentioning

confidence: 99%

The importance of clinical stage among patients with a complete pathologic response at radical cystectomy after neoadjuvant chemotherapy

Parker

Boorjian

et al. 2016

World J Urol

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Patients without evidence of disease at the time of RC are still at risk of recurrence and death from bladder cancer. Higher clinical stage and increased time to RC were associated with an increased risk of recurrence and subsequent death. These data highlight the importance of timely RC and the continued risk of recurrence in higher clinically staged patients-underscoring the need for close monitoring and patient counseling.

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“…Although this rate falls within the range of contemporary RC series, this cohort is highly selected for those with the most favorable MIBC. 3,14,15 Furthermore, 14 of 86 patients (16.3%) with lymph node involvement had positive nodes above the iliac bifurcation. It is not clear if these particular patients benefited from an aggressive lymphadenectomy, but there certainly is a subset of patients with limited nodal disease who are provided a therapeutic benefit with lymphadenectomy.…”

Section: Commentmentioning

confidence: 99%

Outcomes of Radical Cystectomy in Potential Candidates for Bladder Preservation Therapy

Pietzak

Sterling

Smith

et al. 2015

Urology

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Clinical–Pathologic Stage Discrepancy in Bladder Cancer Patients Treated With Radical Cystectomy: Results From the National Cancer Data Base

Cited by 73 publications

References 33 publications

Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

The importance of clinical stage among patients with a complete pathologic response at radical cystectomy after neoadjuvant chemotherapy

Outcomes of Radical Cystectomy in Potential Candidates for Bladder Preservation Therapy

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