Staging of Advanced Bladder Cancer

See, William A.; Fuller, Jeffrey J.

doi:10.1016/s0094-0143(21)00438-9

Cited by 37 publications

(1 citation statement)

References 76 publications

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“…40 -55 A substantial staging error (approximately 50%) exists comparing the clinical stage with the final pathologic stage at cystectomy. [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] It is known that the examination of TURB specimens could not distinguish T2 bladder carcinoma patients from those patients with higher stage cancers. The presence of invasion into adipose tissue in the TURB specimens is not synonymous with extravesical extension because adipose tissue normally is present in the muscular wall of the bladder.…”

Section: Discussionmentioning

confidence: 99%

Substaging of T1 bladder carcinoma based on the depth of invasion as measured by micrometer

Liu

Weaver

Neumann

et al. 1999

Cancer

122

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BACKGROUND.A significant number of T1 bladder carcinoma patients are understaged by transurethral resection of the bladder (TURB), indicating a substantial need for more accurate staging. METHODS.The authors studied 55 patients with T1 bladder carcinoma detected by TURB at the Mayo Clinic between December 1979 and July 1984. The mean age of the patients was 66 years (range, 50 -78 years). All patients were treated by cystectomy. The median interval from TURB to cystectomy was 10 days. Grading was performed according to the 1998 World Health Organization/International Society of Urologic Pathology grading system. The 1997 TNM classification was used for pathologic staging. In addition, the depth of invasion was measured from the mucosal basement membrane by micrometer. Receiver operating characteristic (ROC) analysis was used to evaluate the usefulness of depth of invasion as a marker for advanced stage bladder carcinoma (Ն T2). RESULTS.The final pathologic stages were Ta (2 patients), T1 (10 patients), T2a (9 patients), T2b (13 patients), T3 (11 patients), and T4 (10 patients) at cystectomy.There was a significant correlation between the depth of invasion at TURB and the final pathologic stage (Spearman correlation coefficient ϭ 0.63; P Ͻ 0.001). The overall accuracy for the prediction of advanced stage (Ն T2) bladder carcinoma as measured by the area under the ROC curve was 0.89 (standard error, 0.05). Using 1.5 mm as a threshold (with Ͼ1.5 mm indicating advanced stage disease), the sensitivity, specificity, and positive and negative predictive values were 81%, 83%, 95%, and 56%, respectively. Histologic grade at the time of TURB also was associated significantly with final pathologic stage at cystectomy (P ϭ 0.03) whereas stratification of patients according to invasion above or below the muscularis mucosae at TURB was not a significant predictor of final pathologic stage. CONCLUSIONS.The results of the current study show that substaging of T1 bladder carcinoma according to the depth of invasion (as measured by micrometer) provides significant prognostic information. Therefore the authors recommend that it be reported in specimens obtained by TURB. [See also editorial counterpoint on pages 908 -9 and reply to counterpoint on pages 910 -2, this issue.] Cancer 1999;86: 1035-43.

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Section: Discussionmentioning

confidence: 99%

Substaging of T1 bladder carcinoma based on the depth of invasion as measured by micrometer

Liu

Weaver

Neumann

et al. 1999

Cancer

122

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Future therapies for the treatment of bladder neoplasms

See

Berman

1997

Semin. Surg. Oncol.

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The last several decades have witnessed an exponential growth in the understanding of the biology of human neoplasms. As a consequence, a number of new strategies for the treatment of urologic cancers are currently under evaluation. We provide an overview of promising new treatment approaches as they apply to the management of transitional cell carcinoma of the urinary bladder. Semin. Surg. Oncol. 13:376‐388, 1997. © 1997 Wiley‐Liss, Inc.

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Staging of bladder cancer

Gospodarowicz

1994

Seminars in Surgical Oncology

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The definitive diagnosis of bladder cancer is established at cystoscopic examination and confirmed by means of a transurethral biopsy. A careful bimanual palpation of the bladder under anesthesia is an integral part of the initial assessment of each patient. The most important part of the assessment of patients with bladder cancer is a thorough pathologic examination of the biopsy material establishing the histologic type of tumor, histologic grade, tumor configuration, depth of invasion of the bladder wall, and depth of the bladder wall available for assessment. If possible, the size of the tumor and the presence of associated carcinoma in situ should also be reported. Imaging studies play a smaller role in the clinical staging of bladder cancer. However, when initial staging procedures point to invasion of the muscularis propria, chest X-ray, bone scan, and computed tomography scan of the abdomen and pelvis may provide valuable information about possible metastases. Whereas the clinical staging is essential to select and evaluate therapy, the pathologic stage (pTNM) provides the most precise data with which to estimate prognosis and calculate end results. The pathologic assessment entails resection of the primary tumor or a biopsy adequate to evaluate the highest pT category, removal of lymph nodes adequate to validate the absence of regional lymph node metastasis, as well as biopsy and microscopic examination for assessment of distant metastases. Although numerous factors have an impact on the behaviour of the malignancy, in bladder cancer the anatomic extent of disease reflected in the current staging classification remains the most powerful indicator of outcome.

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Staging of Advanced Bladder Cancer

Cited by 37 publications

References 76 publications

Substaging of T1 bladder carcinoma based on the depth of invasion as measured by micrometer

Substaging of T1 bladder carcinoma based on the depth of invasion as measured by micrometer

Future therapies for the treatment of bladder neoplasms

Staging of bladder cancer

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