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- Title
Upstaging of urothelial cancer at the time of radical cystectomy: factors associated with upstaging and its effect on outcome.
- Authors
Turker, Polat; Bostrom, Peter J; Wroclawski, Marcelo L; van Rhijn, Bas; Kortekangas, Hannes; Kuk, Cynthia; Mirtti, Tuomas; Fleshner, Neil E; Jewett, Michael A; Finelli, Antonio; Kwast, Theo Vander; Evans, Andy; Sweet, Joan; Laato, Matti; Zlotta, Alexandre R
- Abstract
What's known on the subject? and What does the study add? The reported discordance between staging on transurethral bladder resection and on radical cystectomy pathology in the literature ranges from 20 to 80%.Correct staging in bladder cancer has direct implications for its management. The upstaging from organ-confined (OC) to non-organ-confined (nOC) disease has been reported in 40% of cases. Lymphovascular invasion (LVI) is a factor known to be associated with poor clinical outcome. Pathological upstaging was observed in our cohort in 40% of cases and most cases (80%) were upstaged from OC to nOC disease. During the study period the frequency of upstaging observed increased. We found LVI (hazard ratio [HR]= 5.07, 95% CI = 3.0-8.3, P < 0.001) and any histological variant variant (HR = 2.77, 95% CI = 1.6-4.8, P < 0.001) to be strong independent predictors of upstaging. Patients with clinical T2 bladder cancer found with upstaging at the time of radical cystectomy had a poorer outcome than patients with no upstaging. Identification of patients at high risk of upstaging at radical cystectomy is key to improving their management and outcome.
- Publication
BJU international, 2012, Vol 110, Issue 6, p804
- ISSN
1464-410X
- Publication type
Journal Article
- DOI
10.1111/j.1464-410X.2012.10939.x