1032 VALIDATION OF RESIDUAL PATHOLOGIC STAGE AT RADICAL CYSTECTOMY AS A PROGNOSTIC FACTOR IN PATIENTS WITH CT2N0 BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Staging1 Apr 20101032 VALIDATION OF RESIDUAL PATHOLOGIC STAGE AT RADICAL CYSTECTOMY AS A PROGNOSTIC FACTOR IN PATIENTS WITH CT2N0 BLADDER CANCER Shahrokh Shariat, Myrna Khan, Seth Lerner, Gilad Amiel, Robert Svatek, Eila Skinner, Pierre Karakiewicz, Derya Tilki, Patrick Bastian, Wassim Kassouf, Giacomo Novara, Hans-Martin Fritsche, Jonathan Izawa, Vincenzo Ficarra, Colin Dinney, Yves Fradet, and Guru Sonpavde Shahrokh ShariatShahrokh Shariat Dallas, TX More articles by this author , Myrna KhanMyrna Khan Houston, TX More articles by this author , Seth LernerSeth Lerner Houston, TX More articles by this author , Gilad AmielGilad Amiel Houston, TX More articles by this author , Robert SvatekRobert Svatek Houston, TX More articles by this author , Eila SkinnerEila Skinner Los Angeles, CA More articles by this author , Pierre KarakiewiczPierre Karakiewicz Montreal, Canada More articles by this author , Derya TilkiDerya Tilki Muenchen, Germany More articles by this author , Patrick BastianPatrick Bastian Muenchen, Germany More articles by this author , Wassim KassoufWassim Kassouf Montreal, Canada More articles by this author , Giacomo NovaraGiacomo Novara Padua, Italy More articles by this author , Hans-Martin FritscheHans-Martin Fritsche Regensburg, Germany More articles by this author , Jonathan IzawaJonathan Izawa London, Canada More articles by this author , Vincenzo FicarraVincenzo Ficarra Padua, Italy More articles by this author , Colin DinneyColin Dinney Houston, TX More articles by this author , Yves FradetYves Fradet Quebec City, Canada More articles by this author , and Guru SonpavdeGuru Sonpavde Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2067AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We have previously shown that down-staging to non-muscle-invasive disease is associated with improved prognosis in patients undergoing radical cystectomy (RC) for clinical T2N0 urothelial carcinoma of the bladder (UCB) (Isbarn H, et al, J. Urol. 2009). We planned to validate these data in an independent, large, international patient population to facilitate risk stratification of these patients. METHODS The study comprised 688 patients with cT2N0 stage at TUR (transurethral resection) whose tumors were organ-confined at RC (¡ÜpT2N0). cT1N0 patients with pT2 disease at RC (N=137) were also examined. None of the patients had received peri-operative chemotherapy. The effect of residual pT-stage at RC on outcomes was evaluated using Cox-regression analyses. Covariates included age, gender, grade, lymphovascular invasion, concomitant carcinoma-in-situ, number of lymph nodes removed, institution and the year of surgery. RESULTS Residual pT-stage at RC for cT2N0 patients was pT0 in 78 patients (11.3%), pTa in 11 (1.6%), pTis in 81 (11.8%), pT1 in 114 (16.6%), and pT2 in 404 patients (58.7%). The median follow-up was 63.6 months for disease recurrence and 81 months for survival. The 5-year recurrence-free survivals (RFS) of patients with residual pT0/pTa/pTis, pT1 and pT2 were 92.9%, 84.2% and 74.6%, respectively. The 5-year overall survival (OS) rates for the same patient cohorts were 88.5%, 77.1% and 63.4%, respectively. In multivariable analyses, down-staging to ¡ÜpT2 stage at RC was an independent predictor for both RFS (adjusted HR 0.54; p=0.008) and OS (adjusted HR: 0.64; p=0.004). Subgroup analyses revealed no difference in RFS and OS between residual pT1N0 vs. pT2N0 disease Initial cT1 patients who were pT2 at RC did not have statistically different RFS or OS compared to cT2 patients who remained pT2 at RC. CONCLUSIONS This study externally validates that residual muscle-invasive disease compared to residual non-muscle-invasive disease at RC in patients with cT2N0 UCB is a strong and independent prognostic factor. These data facilitate the risk-stratification of patients with pT2N0 disease and enable the selection of high-risk patients for trials evaluating adjuvant therapy. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e401 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shahrokh Shariat Dallas, TX More articles by this author Myrna Khan Houston, TX More articles by this author Seth Lerner Houston, TX More articles by this author Gilad Amiel Houston, TX More articles by this author Robert Svatek Houston, TX More articles by this author Eila Skinner Los Angeles, CA More articles by this author Pierre Karakiewicz Montreal, Canada More articles by this author Derya Tilki Muenchen, Germany More articles by this author Patrick Bastian Muenchen, Germany More articles by this author Wassim Kassouf Montreal, Canada More articles by this author Giacomo Novara Padua, Italy More articles by this author Hans-Martin Fritsche Regensburg, Germany More articles by this author Jonathan Izawa London, Canada More articles by this author Vincenzo Ficarra Padua, Italy More articles by this author Colin Dinney Houston, TX More articles by this author Yves Fradet Quebec City, Canada More articles by this author Guru Sonpavde Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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