Incidence and predictors of understaging in patients with clinical T1 urothelial carcinoma undergoing radical cystectomy

Abstract

Summary Objective To evaluate predictors of understaging in patients with presumed non-muscle invasive bladder cancer (NMIBC) identified on transurethral resection of bladder tumor (TURBT) who underwent radical cystectomy (RC) with attention to the role of a restaging TURBT. Materials and Methods We retrospectively evaluated 279 consecutive patients with clinically staged T1 (cT1) disease following TURBT who underwent RC at our institution from April 2000 to July 2011. 60 of these cT1 patients had undergone a restaging TURBT prior to RC. The primary outcome measure was pathological staging of T2 or greater disease at the time of RC. Results 134 (48.0%) patients were understaged. Of the 60 patients who remained cT1 after a restaging TURBT, 28 (46.7%) were understaged. Solitary tumor (OR 0.43, 95% CI 0.25–0.76, p = 0.004) and fewer prior TURBTs (OR 0.84, 95% CI 0.71–1.00, p = 0.05) were independent risk factors for understaging. Conclusions Despite the overall improvement in staging accuracy linked to restaging TURBTs, the risk of clinical understaging remains high in restaged patients found to have persistent T1 urothelial carcinoma who undergo RC. Solitary tumor and fewer prior TURBTs are independent risk factors for being understaged. Incorporating these predictors into preoperative risk stratification may allow for augmented identification of those patients with clinical NMIBC who stand to benefit most from RC.

Evaluation of the value of the VI-RADS scoring system in assessing muscle infiltration by bladder cancer

“…At present, the stage of bladder cancer is mainly determined by the combination of imaging (including CT, MRI, etc.) and pathological examination (tumor samples are obtained by diagnostic transurethral resection, and a biopsy is performed), but thus far, these methods are not completely accurate [6][7][8][9][10], so we urgently need a more reliable tool to assess the clinical stage and guide clinical management.…”

Diagnostic Value of Pre treatment Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Lymphocyte-to-Monocyte Ratio for Invasive Bladder Carcinoma

“…Researchers have attempted to improve the staging process by combining histology, molecular markers and imaging modalities such as computed tomography or magnetic resonance imaging into predictive nomograms. Both Karakiewicz et al [14] and Margel et al [15] presented nomograms to predict organ-confined disease before cystectomy. Margel et al utilised molecular markers for this.…”

Multicenter Analysis of the Oncological Positivity on Restaging Resection (Re-Turbt) of Urothelial Non-Muscle-Invasive Bladder Cancer

“…In a study of 57 patients with T1 disease who underwent radical cystectomy, Stenberg et al found 25% of muscle invasive (T2) tumors, whereas Ark et al had 45% of muscle invasive tumors diagnosed in immediate cystectomy of patients who had T1 histological tumors on re-TURBT. Interestingly, Herr also defends that that the upstaged disease often found in the immediate cystectomy of patients who had pT1 tumors at re-TURBT justify the non-conservative approach for these patients after re-TURBT, against the intravesical BCG therapy [17][18][19] had we followed these recommendations 13 other patients would have undergone cystectomy, resulting in a major increase in the number of cystectomies after re-TURBT.…”