Comparison of American Joint Committee on Cancer pathologic stage T3a versus T3b urothelial carcinoma: Analysis of patient outcomes

Abstract

BACKGROUND: The radical cystectomy experience at Vanderbilt University Medical Center was scrutinized to determine whether there was a difference in survival between patients with lymph node‐negative pathologic T3a versus pathologic T3b urothelial carcinoma of the bladder. METHODS: Pathologic and clinical data were reviewed on patients who underwent radical cystectomy for urothelial carcinoma between 1995 and 2005. We excluded patients with nontransitional cell cancer, lymph node disease, or with unknown lymph node status. Of the 790 reviewed patients, 75 patients (9.4%) were diagnosed with pathologic T3 urothelial cancer of the bladder. The impact of pathologic substaging (pT3a vs pT3b) was examined to determine the effect on overall, disease‐specific, and recurrence‐free survival. RESULTS: The mean age was 68.6 years (36 years to 83 years). Median overall follow‐up was 25.3 months (1.13 months to 130.17 months). Median follow‐up for patients alive at last follow‐up was 55.9 months (25.3 months to 130.2 months). Actuarial overall survival at 5 years was 29.5% for pT3a and 29.3% for pT3b (P = .79). Actuarial disease‐specific survival at 5 years was 54.1% for pT3a and 42.4% for pT3b (P = .21). Actuarial recurrence‐free survival at 5 years was 68.1% for pT3a and 71.9% for pT3b (P = .53). CONCLUSIONS: There were no significant differences in overall, disease‐specific, or recurrence‐free survival when comparing lymph node‐negative pT3a versus pT3b urothelial cancer of the bladder following radical cystectomy. Simplification of pathologic staging for urothelial carcinoma of the bladder should be considered at future revisions of the American Joint Committee on Cancer staging system. Cancer 2009. © 2009 American Cancer Society.

Prognostic Significance of Measured Depth of Invasion of Urothelial Carcinoma of the Bladder Compared to the 2010 American Joint Committee on Cancer pT2 and pT3 Classifications

“…Our results regarding AJCC substaging in patients with pT3 tumors again parallel the findings of Boudreaux et al 5 Specifically, in 75 patients with pT3 tumors they reported a 5-year CSS of 54.1% and 42.4% for pT3a and pT3b disease, respectively (p ϭ 0.21). In addition, 2 studies by Quek et al in 129 and 236 patients with pT3 disease revealed no significant difference in recurrence-free and overall survival between patients with pT3a and pT3b urothelial carcinoma following radical cystectomy.…”

“…However, the clinical significance of these substratifications continue to be debated with conflicting data from large studies in regard to outcome, and pT2 and pT3 substages. [2][3][4][5][6][7][8][9][10][11] To our knowledge none of the studies to date that evaluated the prognostic significance of pathological 1706 www.jurology.com substaging included a centralized pathological review by urological pathologists. In our experience there is interobserver variability in the current definition of pT3 substaging in regard to microscopic vs macroscopic invasion, while an extravesical mass is not well defined.…”

Outcome of Patients with Pathological Tumor Stage T3 Urothelial Carcinoma of the Bladder following Radical Cystectomy in a Single-Center Series with 116 Patients

“…In order to diminish the potential bias of LNI, we calculated the same models after excluding all patients with positive lymph nodes (n = 50) using multivariable Cox regression models. Similar to previous studies addressing this issue [5,7,8], pT3 substage in our node-negative cohort of 66 patients had no independent impact on survival (data not shown). …”

“…Subsequently, several authors presented their findings addressing the prognostic impact of pT3a versus pT3b tumors [5,6,7,8,9,10,11]. However, data addressing this issue is far from conclusive and still under debate.…”

“…However, data addressing this issue is far from conclusive and still under debate. While some study groups were unable to detect any difference in survival [5,6,7,8], others demonstrated a prognostic relevance of the substaging revision and integrated the substaged pT3 in assessment tools [9,10,11]. …”