Comparison of microscopic (pT3a) and gross extravesical extension (pT3b) in pathological staging of bladder cancer: analysis of patient outcomes

Dinçel, Çetin; Kara, Cengiz; Balcı, Uğur; Ozer, Kutan; Özbir, Sait; Şefik, Ertuğrul; Görgel, Sacit Nuri; Girgin, Cengiz

doi:10.1007/s11255-013-0381-7

Cited by 11 publications

(8 citation statements)

References 11 publications

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“…examined 236 patients (median follow‐up = 8.9 years) with pT3 urinary bladder cancer and found no significant difference in recurrence or survival rates between patients with pT3a and pT3b tumours; lymph node and surgical margin status were the only factors to impact patient prognosis significantly among pT3 patients. Other studies have also demonstrated similar findings . Conversely, several recent, large studies have found that pT3b is associated with worse outcome compared to pT3a .…”

Section: Stage Pt3 Carcinomasupporting

confidence: 52%

“…Other studies have also demonstrated similar findings. 100,117,118 Conversely, several recent, large studies have found that pT3b is associated with worse outcome compared to pT3a. [112][113][114]119 For example, Tilki et al 120 included 808 patients who underwent radical cystectomy with stage pT3 and found that although there was no significant difference overall in outcome of pT3a versus pT3b patients, of the patients without lymph node metastasis (pN0) pT3b was associated with significantly worse 5-year recurrence-free survival (47.9 versus 60.7%) and cancerspecific survival (55.0 versus 64.4%) compared to pT3apN0 patients.…”

Section: Stage Pt3 Carcinomamentioning

confidence: 99%

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Staging of bladder cancer

et al. 2018

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Urothelial carcinoma of the urinary bladder is a heterogeneous disease with multiple possible treatment modalities and a wide spectrum of clinical outcome. Treatment decisions and prognostic expectations hinge on accurate and precise staging, and the recently published American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition, should be the basis for staging of urinary bladder tumours. It is unfortunate that the International Union Against Cancer (UICC) 8th edition failed to incorporate new data which is considered in the AJCC 8th edition. Thus, the AJCC 8th edition is the focus of this review. Several critical changes and clarifications are made by the AJCC 8th edition relative to the 7th edition. Although the most obvious changes in the 8th edition are in the N (i.e. perivesical lymph node involvement now classified as N1) and M (i.e. M1 is subdivided into M1a and M1b) categories, several points are clarified in the T category (e.g. substaging of pT1 should be attempted). Further optimisation, however, is required. No particular method of substaging pT1 is formally recommended. In this review, these modifications are discussed, as well as points, which require further study and optimisation.

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Section: Stage Pt3 Carcinomasupporting

confidence: 52%

Section: Stage Pt3 Carcinomamentioning

confidence: 99%

Staging of bladder cancer

et al. 2018

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“…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). …”

Section: Discussionsupporting

confidence: 91%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Breyer¹,

Denzinger²,

Otto³

et al. 2014

Urol Int

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Objective: Outcome prediction of pT3 urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC) remains challenging. The objective of our study was to determine high-risk patients with poor survival outcome in a heterogeneous group substaged pT3 who might profit from early adjuvant chemotherapy. Materials and Methods: We compiled clinicopathological and immunohistochemical data of E-cadherin (E-cad) expression in 116 patients with pT3 UCB after RC in our single-center series. Multivariable Cox regression models including substaged pT3 established clinicopathological features, and the expression of the predictive immunohistochemical feature E-cad was used to identify independent predictors on progression-free (PFS), cancer-specific (CSS) and overall survival (OS), respectively. Results: No significant differences were found addressing clinicopathological data and substaged pT3. In multivariable Cox regression models, lymph node involvement was an independent predictor for PFS (p < 0.001), CSS (p < 0.001) and OS (p = 0.002), respectively. Lymphovascular invasion (LVI) significantly influenced PFS (p = 0.016). ASA score 3/4 independently predicted CSS (p = 0.049) and OS (p = 0.032). Neither pT3 substages nor E-cad expression were significant prognosticators for survival. Conclusions: In pT3 UCB patients with ASA 3/4, positive lymph node status and/or presence of LVI, administration of chemotherapy should be considered due to the high risk of poor oncological outcome. The immunohistochemical marker E-cad was not an independent predictor.

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